CPT code 87385: Histoplasma antigen, qualitative or semiquantitative2026 Medicare lab fee · Clinical Laboratory Fee Schedule
An immunoassay detects Histoplasma capsulatum antigen to support evaluation for histoplasmosis, including suspected disseminated infection.
Medicare pays $13.25 for 87385 under the 2026 Clinical Laboratory Fee Schedule: one national amount, the same in every state and setting.
Medicare lab fee · CLFS 2026 Q4
National CLFS amount
$13.25
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2020
- Unchanged
- CMS updates
- Quarterly
Medicare pays the lesser of the lab’s charge and this amount. Patients usually owe no Part B deductible or coinsurance for covered clinical lab tests.
On this page 7 sections
What 87385 covers
This laboratory assay detects Histoplasma capsulatum antigen by immunoassay and produces a qualitative or semiquantitative result. It supports evaluation for histoplasmosis when clinical findings raise concern for infection, including possible disseminated disease. A clinical laboratory typically performs and reports the test on submitted patient material; the code identifies an antigen assay, rather than antibody testing or organism culture.
Report 87385 for the Histoplasma antigen immunoassay performed. Medicare pays it through the CLFS, with one national amount across states and localities and no office-versus-facility difference. The 2026 national CLFS amount is $13.25, unchanged since 2020. The test is paid only from the CLFS and is excluded from the physician fee schedule.
This summary was written with AI assistance from CMS Clinical Laboratory Fee Schedule data. Amounts on this page come directly from CMS files.
How Medicare pays 87385
Clinical lab tests aren’t priced like physician services. They’re paid from their own fee schedule, with its own rules. See the whole lab fee schedule.
One national amount
CMS sets a single Clinical Laboratory Fee Schedule amount for 87385. There’s no geographic (GPCI) adjustment, so it pays the same in every state and payment locality.
No office or facility rate
Lab tests aren’t built from relative value units, so there’s no office and facility split: the place of service doesn’t change the CLFS amount.
Updated every quarter
CMS republishes the CLFS each quarter. New tests, often proprietary laboratory analyses (PLA codes), join during the year; existing amounts are updated each January.
Excluded from the physician fee schedule
The physician fee schedule lists 87385 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87385 on the lab fee schedule since 2020
87385 · CLFS 2026 Q4 (current)
$13.25
Unchanged since Jan 1, 2020
27 quarterly CLFS releases on file, first CLFS 2020 Q1. A code missing from a quarter wasn’t on that release.
87385 compared with similar tests
- 87305Aspergillus antigenImmunoassay detection$11.98
- Use 87385 for Histoplasma antigen and 87305 for Aspergillus antigen. The target organism determines the code.
- 87327Cryptococcus antigenMultistep immunoassay$13.42
- Use 87385 for Histoplasma antigen and 87327 for Cryptococcus neoformans antigen; these assays detect different organisms.
87385 billing questions
How does 87385 differ from a Histoplasma antibody test?
87385 identifies an antigen immunoassay. An antibody assay measures the patient's immune response and is a different test.
How is 87385 distinguished from other fungal antigen codes?
Select 87385 when the assay detects Histoplasma capsulatum antigen. Codes such as 87305 and 87327 identify assays for different organisms.
Does 87385 represent a qualitative or quantitative result?
The assay may be qualitative or semiquantitative. The code does not indicate a separate quantitative measurement.
What should the record support?
Documentation should identify the Histoplasma antigen assay performed and the clinical reason for testing, such as evaluation for suspected histoplasmosis.
How does Medicare pay for 87385?
Medicare pays the test through the CLFS at one national amount, regardless of locality or office versus facility setting. The test is excluded from the physician fee schedule.
Where this amount comes from
FeeBase reads lab amounts directly from the CMS Clinical Laboratory Fee Schedule file for the quarter: one row per code, with its payment indicator and national amount. Contractor-priced tests are labeled, never given a made-up amount. Amounts are Medicare payment limits, not a patient’s bill or a commercial rate.
CMS CLFS 2026 Q4 · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file line behind this amount
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