CPT code 87475: Lyme DNA test, direct-probe detection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Direct-probe nucleic-acid testing detects Borrelia burgdorferi and is reported when that organism is tested by this method.
Medicare pays $20.05 for 87475 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
$20.05
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
- 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 87475 covers
This assay detects Borrelia burgdorferi nucleic acid by direct-probe testing. It reports organism detection rather than an antibody measurement or an amplification-based assay. Code selection follows the method performed: direct-probe detection is distinct from the amplification method represented by 87476. The target is B. burgdorferi; testing for a different Borrelia species is not reported with this code.
Medicare pays 87475 under the CLFS at one nationally set amount in every state and locality, with no geographic or office/facility adjustment. The 2026 national CLFS amount is $20.05, unchanged since 2020. Medicare pays this test only from the CLFS, not 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 87475
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 87475. 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 87475 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87475 on the lab fee schedule since 2020
87475 · CLFS 2026 Q4 (current)
$20.05
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.
87475 compared with similar tests
- 87476Lyme DNA testAmplified probe$35.09
- Both codes target B. burgdorferi nucleic acid. Use 87475 for direct-probe detection and 87476 when the method uses amplification.
- 87478B. miyamotoi testAmplified probe$35.09
- 87478 targets Borrelia miyamotoi, a different species; 87475 targets B. burgdorferi.
- 86618Lyme antibodyLyme disease antibody$17.03
- 86618 reports Lyme antibody testing, while 87475 detects B. burgdorferi nucleic acid by direct probe.
87475 billing questions
How does 87475 differ from 87476?
Both target Borrelia burgdorferi nucleic acid, but 87475 is for direct-probe detection and 87476 is for amplification-based detection. Select the code that matches the method performed.
Is 87475 a Lyme antibody test?
No. It detects B. burgdorferi nucleic acid; antibody testing measures the patient’s immune response and is reported with a different code, such as 86618.
Does 87475 report a quantitative result?
No. This code describes direct-probe detection of B. burgdorferi nucleic acid, not quantification.
How does Medicare pay for 87475?
Medicare pays the test under the CLFS using one national amount across states and localities, without geographic or office/facility adjustment. It is paid only from the CLFS.
What should the laboratory documentation support?
Documentation should support that the test performed targeted B. burgdorferi nucleic acid using a direct-probe method. Use an amplification code when amplification-based detection was performed.
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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