CPT code 87430: Strep A antigen, immunoassay detection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
An immunoassay detects group A Streptococcus antigen, commonly from a throat swab when evaluating suspected streptococcal pharyngitis.
Medicare pays $16.81 for 87430 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
$16.81
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
- QW · CLIA-waived test
- $16.81
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 87430 covers
This test detects group A Streptococcus antigen using an immunoassay and reports a qualitative or semiquantitative result. It is commonly performed on a throat swab during evaluation of suspected streptococcal pharyngitis. Physician offices, urgent care centers, and clinical laboratories may perform or report the test. For the CLIA-waived version, sites holding a CLIA certificate of waiver report modifier QW.
Medicare pays the test only under the Clinical Laboratory Fee Schedule. The 2026 national CLFS amount is $16.81, unchanged since 2020. One amount applies across states and localities, without geographic or office-versus-facility adjustment.
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 87430
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 87430. 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 87430 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87430 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $16.81.
87430 on the lab fee schedule since 2020
87430 · CLFS 2026 Q4 (current)
$16.81
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.
87430 compared with similar tests
- 87880Rapid strep testGroup A antigen, visual$16.53
- Both detect group A strep antigen by immunoassay. Use 87880 when the assay uses direct optical observation; use 87430 for the immunoassay method without direct optical observation.
- 87651Strep A testAmplified nucleic acid$35.09
- 87651 is a molecular amplification test for group A strep nucleic acid. 87430 detects antigen by immunoassay.
- 87070Aerobic cultureNon-urine, blood, or stool$8.62
- 87070 represents a bacterial culture. Choose it when a culture is performed rather than an antigen immunoassay.
87430 billing questions
When should this code be chosen over 87880?
Use 87430 for group A Streptococcus antigen detection by immunoassay when the assay does not use direct optical observation. Select the code that matches the assay performed.
How does 87430 differ from a molecular strep test?
87430 detects antigen by immunoassay. A molecular assay such as 87651 detects group A Streptococcus nucleic acid by an amplification method.
What specimen is typically tested?
A throat swab is commonly collected when evaluating suspected group A strep pharyngitis. Report the service performed on the specimen tested.
When is modifier QW reported?
Modifier QW identifies the CLIA-waived version of this test. Report it for the waived test performed at a site holding a CLIA certificate of waiver.
How does Medicare pay this test?
Medicare pays 87430 through the CLFS. The same national amount applies in every locality, without an office-versus-facility adjustment.
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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