CPT code 87468: Anaplasma test, amplified nucleic acid2026 Medicare lab fee · Clinical Laboratory Fee Schedule
An amplified nucleic acid test detects Anaplasma phagocytophilum, commonly in patients evaluated for a tick-borne infection such as anaplasmosis.
Medicare pays $35.09 for 87468 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
$35.09
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
- 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 8 sections
What 87468 covers
This molecular laboratory assay detects Anaplasma phagocytophilum genetic material using nucleic acid amplification. It is ordered in evaluation of suspected anaplasmosis, often when a patient has a compatible febrile illness and possible tick exposure. Whole blood is a commonly used specimen. Clinical laboratories perform the assay for clinicians evaluating possible infection.
Report this code for the Anaplasma phagocytophilum amplified-probe test, not for testing for a different tick-borne organism or for a quantitative result. Medicare pays the test through the Clinical Laboratory Fee Schedule. The 2026 national CLFS amount is $35.09, unchanged from 2023 through 2026; one national amount applies across localities, without a geographic or office-versus-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 87468
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 87468. 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 87468 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87468 on the lab fee schedule since 2023
87468 · CLFS 2026 Q4 (current)
$35.09
Unchanged since Jan 1, 2023
16 quarterly CLFS releases on file, first CLFS 2023 Q1. A code missing from a quarter wasn’t on that release.
87468 compared with similar tests
- 87484Ehrlichia testAmplified probe$35.09
- Both are amplified nucleic acid tests for tick-borne pathogens, but this code detects Anaplasma phagocytophilum and 87484 detects Ehrlichia chaffeensis.
- 87469Babesia testAmplified nucleic acid$35.09
- This code detects Anaplasma phagocytophilum; 87469 detects Babesia microti. Choose based on the organism targeted by the assay.
- 87476Lyme DNA testAmplified probe$35.09
- Both use amplified nucleic acid testing, but 87476 detects Lyme disease-associated Borrelia rather than Anaplasma phagocytophilum.
87468 billing questions
When should this code be selected instead of the Ehrlichia test?
Use this code when the assay detects Anaplasma phagocytophilum. The Ehrlichia test, 87484, detects Ehrlichia chaffeensis; select according to the organism tested.
How does this test differ from the Babesia test?
This code identifies Anaplasma phagocytophilum by amplified nucleic acid testing. Code 87469 is for Babesia microti.
Is this a quantitative test?
No. This code identifies an amplified nucleic acid detection test, not a quantitative assay.
How does Medicare pay for the test?
Medicare pays through the CLFS at one national amount across localities, with no office-versus-facility difference. 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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