CPT code 87486: C. pneumoniae test, amplified probe2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This amplified-probe nucleic acid assay detects Chlamydia pneumoniae and is reported when the laboratory performs organism detection rather than quantitative testing.
Medicare pays $35.09 for 87486 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 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 87486 covers
This laboratory assay detects Chlamydia pneumoniae nucleic acid using an amplified-probe technique. It identifies the organism rather than reporting a quantity, distinguishing it from quantitative testing for the same target. Report 87486 when that amplified-probe method is performed; the code is specific to C. pneumoniae and should not be selected solely because another Chlamydia species is being tested. The test may be ordered as part of an evaluation for suspected C. pneumoniae infection.
Medicare pays this service only through the CLFS, not the physician fee schedule. The 2026 national CLFS amount is $35.09 and has been unchanged since 2020. One national amount applies in every state and locality, with no geographic adjustment or office-versus-facility payment difference. The distinction between amplified-probe detection and direct-probe or quantitative testing depends on the assay performed.
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 87486
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 87486. 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 87486 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87486 on the lab fee schedule since 2020
87486 · CLFS 2026 Q4 (current)
$35.09
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.
87486 compared with similar tests
- 87485C. pneumoniae testDirect probe technique$20.05
- Both test for C. pneumoniae. Use 87486 for the amplified-probe method and 87485 for direct-probe detection.
- 87487Chlamydia pneumoniaeQuantitative DNA assay$42.84
- Both target C. pneumoniae, but 87487 is for quantitative testing; 87486 represents amplified-probe detection.
- 87491Chlamydia testAmplified nucleic acid detection$35.09
- Code 87491 targets C. trachomatis, not C. pneumoniae. Select according to the organism tested.
87486 billing questions
How does 87486 differ from 87485?
Both detect C. pneumoniae, but 87486 identifies the amplified-probe method and 87485 identifies the direct-probe method.
When is 87487 used instead?
Use 87487 for quantitative C. pneumoniae testing. Code 87486 is for amplified-probe detection rather than quantification.
What should the claim documentation identify?
Documentation should support the C. pneumoniae target and the amplified-probe assay performed.
How does Medicare pay this test?
Medicare pays it through the CLFS at one national amount across localities, with no office or facility adjustment.
Is 87491 the same test?
No. Code 87491 targets Chlamydia trachomatis, while 87486 targets C. pneumoniae.
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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