CPT code 87428: Respiratory antigen test, SARS-CoV-2 and influenza A/B2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This combined antigen immunoassay detects SARS-CoV-2 and influenza A and B and is reported when all three targets are tested together.
Medicare pays $70.29 for 87428 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
$70.29
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2022
- +127.2%
- QW · CLIA-waived test
- $70.29
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 87428 covers
This immunoassay detects antigens from SARS-CoV-2 and influenza virus types A and B in a combined test. It is used in evaluating acute respiratory illness when these viral infections are considered. Results may be qualitative or semiquantitative. Clinical laboratories perform the assay, and sites with a CLIA certificate of waiver may perform its waived version. Modifier QW identifies the CLIA-waived version.
Medicare pays 87428 under the CLFS rather than the physician fee schedule. The 2026 national CLFS amount is $70.29, unchanged since 2024. One national amount applies in every state and locality, with no geographic adjustment or office-versus-facility difference. The code represents the combined antigen immunoassay; the method distinguishes it from molecular testing for the same viral targets.
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 87428
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 87428. 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 87428 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87428 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $70.29.
87428 on the lab fee schedule since 2021
87428 · CLFS 2026 Q4 (current)
$70.29
Up 127.2% from $30.94 in 2022
Every change on file
- Jan 1, 2024 · CLFS 2024 Q1MAC-priced → $70.29
- Jan 1, 2023 · CLFS 2023 Q1$30.94 → MAC-priced
- Jan 1, 2022 · CLFS 2022 Q1MAC-priced → $30.94
24 quarterly CLFS releases on file, first CLFS 2021 Q1. A code missing from a quarter wasn’t on that release.
87428 compared with similar tests
- 87426Coronavirus antigenQualitative or semiquantitative$35.33
- 87426 is for SARS-CoV-2 antigen detection alone. Choose 87428 when the antigen test also evaluates influenza A and B.
- 87400Influenza antigenEach type tested$14.13
- 87400 is for influenza A/B antigen testing. Choose 87428 when the combined test includes SARS-CoV-2 as well.
- 87636Respiratory testCOVID-19 and influenza A/B$142.63
- 87636 evaluates the same three viral targets using nucleic acid amplification. 87428 is the antigen immunoassay option.
87428 billing questions
When should 87428 be used instead of 87426?
Use 87428 when the antigen test evaluates SARS-CoV-2 and influenza A and B together. Use 87426 when the test evaluates SARS-CoV-2 alone.
How does 87428 differ from 87400?
87428 represents the combined SARS-CoV-2 and influenza A/B antigen test. 87400 is for influenza A and B antigen testing without the combined SARS-CoV-2 test.
Does 87428 describe antigen or molecular testing?
87428 describes an antigen immunoassay. Code 87636 is an alternative for testing the same three viral targets by nucleic acid amplification.
Is modifier QW appropriate?
CMS recognizes QW for the CLIA-waived version of this test. The waived version may be performed at a site holding a CLIA certificate of waiver.
Does Medicare payment vary by locality or setting?
No. Medicare pays 87428 under the CLFS using one national amount across localities, without an office-versus-facility difference.
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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