CPT code 87478: B. miyamotoi test, amplified probe2026 Medicare lab fee · Clinical Laboratory Fee Schedule
An amplified-probe nucleic acid test detects Borrelia miyamotoi and is reported when molecular testing is performed for suspected infection.
Medicare pays $35.09 for 87478 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 87478 covers
Code 87478 identifies a molecular assay that detects Borrelia miyamotoi nucleic acid with an amplified-probe method. It is used when a clinician is evaluating suspected B. miyamotoi infection. The organism tested determines whether this assay is appropriate; it is distinct from Lyme disease testing and assays for other organisms, such as Babesia microti. Clinical laboratories perform and report this organism-specific molecular test.
Report code 87478 for the B. miyamotoi amplified-probe assay. Medicare pays the test under the CLFS at one national amount across localities, with no geographic or office/facility adjustment. The 2026 national CLFS amount is $35.09, unchanged since 2023. Code 87478 is paid only through the CLFS and 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 87478
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 87478. 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 87478 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87478 on the lab fee schedule since 2023
87478 · 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.
87478 compared with similar tests
- 87469Babesia testAmplified nucleic acid$35.09
- Use 87478 for Borrelia miyamotoi and 87469 for Babesia microti; both use amplified-probe nucleic acid testing.
- 87476Lyme DNA testAmplified probe$35.09
- Code 87476 tests for Lyme disease using an amplified probe. Code 87478 targets Borrelia miyamotoi.
- 87475Lyme DNA testDirect-probe detection$20.05
- Code 87475 is a direct-probe Lyme disease test. Code 87478 detects Borrelia miyamotoi using an amplified probe.
87478 billing questions
How is this test different from a Lyme disease test?
Code 87478 detects Borrelia miyamotoi. Lyme disease nucleic acid tests target a different organism, so select the code that matches the organism and method performed.
How does it differ from the Babesia microti test?
Code 87478 identifies B. miyamotoi, while 87469 identifies Babesia microti. Use the code for the organism the laboratory tested.
Which code describes amplified-probe testing for Lyme disease?
Code 87476 describes amplified-probe testing for Lyme disease. Code 87478 is for B. miyamotoi.
Is code 87478 paid under the physician fee schedule?
No. Medicare pays this test only through the CLFS.
Does Medicare apply a local or office/facility adjustment?
No. Medicare pays one national CLFS amount across localities, without an office or 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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