CPT code 87469: Babesia test, amplified nucleic acid2026 Medicare lab fee · Clinical Laboratory Fee Schedule
An amplified nucleic acid test for Babesia microti, reported when clinicians evaluate suspected babesiosis and need organism-specific molecular detection.
Medicare pays $35.09 for 87469 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 7 sections
What 87469 covers
This molecular assay detects Babesia microti nucleic acid, typically in a blood specimen. Clinicians may order it when evaluating suspected babesiosis, such as febrile illness after possible tick exposure. Babesia infection can cause hemolytic illness, and severe disease is more likely in people without a spleen or with impaired immunity. Clinical laboratories perform and report the organism-specific assay for hospitals, clinics, and other ordering providers.
Report 87469 for amplified nucleic acid detection of Babesia microti, rather than antibody testing or a multi-organism panel as a single test. Medicare pays the test through the CLFS at one national amount in every state and locality, with no office-versus-facility difference. The 2026 national CLFS amount is $35.09, unchanged from 2023 through 2026. The test is paid only through the CLFS.
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 87469
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 87469. 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 87469 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87469 on the lab fee schedule since 2023
87469 · 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.
87469 compared with similar tests
- 87468Anaplasma testAmplified nucleic acid$35.09
- 87468 targets Anaplasma phagocytophilum; 87469 targets Babesia microti. Choose according to the organism assayed, not simply the presence of tick exposure.
- 87484Ehrlichia testAmplified probe$35.09
- 87484 detects Ehrlichia chaffeensis nucleic acid, while 87469 detects Babesia microti. They are organism-specific tests, not interchangeable codes.
- 87476Lyme DNA testAmplified probe$35.09
- 87476 is an amplified nucleic acid test for Lyme disease; 87469 is for Babesia microti.
87469 billing questions
When should 87469 be chosen over another tick-borne organism code?
Use 87469 when the amplified nucleic acid assay targets Babesia microti. Codes such as 87468 and 87484 identify different organisms.
Does 87469 describe antibody testing?
No. It identifies amplified nucleic acid detection of Babesia microti, rather than a serologic antibody test.
Does this code represent a tick-borne disease panel?
No. It identifies the Babesia microti assay, not a multi-organism panel as a single test. Report other organism-specific tests under their applicable codes when those tests are performed.
How does Medicare pay for 87469?
Medicare pays it under the CLFS at one national amount across localities, with no office-versus-facility payment 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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