CPT code 87425: Rotavirus test, antigen immunoassay2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Detects rotavirus antigen by immunoassay, typically in stool testing for patients with acute gastroenteritis or suspected rotavirus infection.
Medicare pays $11.98 for 87425 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
$11.98
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 87425 covers
This test detects rotavirus antigen using an immunoassay and reports a qualitative or semiquantitative result. A stool specimen is commonly tested when evaluating acute gastroenteritis, especially in infants and young children. Clinical laboratories perform the assay and report the result to the ordering clinician.
Report 87425 for the rotavirus antigen assay performed; it identifies rotavirus testing rather than a nucleic-acid test or a test for another infectious agent. Medicare pays the test only under the Clinical Laboratory Fee Schedule (CLFS). The 2026 national CLFS amount is $11.98, unchanged from 2020 through 2026. One national amount applies across states and localities, without an office or facility adjustment. The code 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 87425
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 87425. 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 87425 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87425 on the lab fee schedule since 2020
87425 · CLFS 2026 Q4 (current)
$11.98
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.
87425 compared with similar tests
- 87427Shiga toxin testAntigen immunoassay$11.98
- Choose 87425 when the assay detects rotavirus antigen. Use 87427 for Shiga-like toxin antigen testing.
- 87449Other antigen testEach organism, unspecified target$11.98
- 87425 identifies a rotavirus antigen assay. 87449 is for an infectious-agent antigen assay not otherwise specified.
- 87420RSV antigenImmunoassay method$13.91
- 87425 is for rotavirus antigen, commonly tested in stool; 87420 is for respiratory syncytial virus antigen.
87425 billing questions
What specimen is typically tested?
A stool specimen is commonly used for rotavirus antigen testing.
How is 87425 different from 87427?
87425 detects rotavirus antigen. 87427 is for Shiga-like toxin antigen testing.
Is 87425 an antigen test or a molecular test?
It reports rotavirus antigen detection by immunoassay, with a qualitative or semiquantitative result. It is not a nucleic-acid amplification test.
How does Medicare classify this test for payment?
Medicare pays 87425 under the CLFS only. Its national amount applies uniformly across localities and office and facility settings.
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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