CPT code 87426: Coronavirus antigen, qualitative or semiquantitative2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Immunoassay detection of SARS coronavirus antigen, including SARS-CoV-2, reported for qualitative or semiquantitative antigen testing.
Medicare pays $35.33 for 87426 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
$35.33
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2023
- Unchanged
- QW · CLIA-waived test
- $35.33
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 8 sections
What 87426 covers
87426 identifies an immunoassay that detects antigen from a severe acute respiratory syndrome coronavirus, including SARS-CoV and SARS-CoV-2. The result is qualitative or semiquantitative. This is an antigen test, not a nucleic acid amplification test. Clinical laboratories and sites performing CLIA-waived testing may report the assay when performed to evaluate for coronavirus infection.
Report 87426 for the antigen immunoassay performed. CMS lists modifier QW for the CLIA-waived version at sites holding a CLIA certificate of waiver. Medicare pays the test under the CLFS at one national amount applicable across states and localities, without geographic or office/facility adjustment. The 2026 national CLFS amount is $35.33, unchanged from 2023 through 2025. Payment is through the CLFS only.
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 87426
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 87426. 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 87426 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87426 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $35.33.
87426 on the lab fee schedule since 2020
87426 · CLFS 2026 Q4 (current)
$35.33
Unchanged since Jan 1, 2023
Every change on file
- Jan 1, 2023 · CLFS 2023 Q1MAC-priced → $35.33
25 quarterly CLFS releases on file, first CLFS 2020 Q4. A code missing from a quarter wasn’t on that release.
87426 compared with similar tests
- 87428Respiratory antigen testSARS-CoV-2 and influenza A/B$70.29
- Choose 87426 for a SARS coronavirus antigen immunoassay alone. Choose 87428 when the assay detects SARS-CoV-2 together with influenza A and B antigens.
- 87400Influenza antigenEach type tested$14.13
- 87400 is an antigen immunoassay for influenza A and B; 87426 detects SARS coronavirus antigen.
- 87420RSV antigenImmunoassay method$13.91
- 87420 detects respiratory syncytial virus antigen, while 87426 detects SARS coronavirus antigen.
87426 billing questions
How does 87426 differ from 87428?
87426 reports a SARS coronavirus antigen immunoassay. Code 87428 is for a combined SARS-CoV-2 and influenza A/B antigen assay.
When is modifier QW appropriate?
Use QW for the CLIA-waived version when testing is performed at a site holding a CLIA certificate of waiver.
Does 87426 include influenza antigen testing?
No. Code 87426 is for SARS coronavirus antigen detection; 87428 describes a combined SARS-CoV-2 and influenza A/B antigen assay.
What type of result does this assay provide?
The immunoassay provides a qualitative or semiquantitative antigen result.
Does 87426 cover SARS-CoV as well as SARS-CoV-2?
Yes. The code describes antigen detection for severe acute respiratory syndrome coronaviruses, including SARS-CoV and SARS-CoV-2.
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
Fee sheets
Put 87426 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet