CPT code 87494: CT/NG assay, multiplex amplified probe2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This multiplex nucleic acid test detects Chlamydia trachomatis and Neisseria gonorrhoeae together and is reported when that combined assay is performed.
Medicare pays $70.18 for 87494 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
$70.18
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2026
- Unchanged
- QW · CLIA-waived test
- $70.18
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 87494 covers
Code 87494 identifies a nucleic acid detection test that uses a multiplex amplified-probe technique to detect Chlamydia trachomatis and Neisseria gonorrhoeae in the same assay. The test targets DNA or RNA. It is distinguished from single-organism chlamydia or gonorrhea assays by its combined targets and from direct-probe or quantitative chlamydia tests by its method and scope. Select this code when the performed assay uses the combined targets and multiplex amplified-probe method.
CMS lists a CLIA-waived version with modifier QW; use QW when the waived test is performed by a site holding a CLIA certificate of waiver. Medicare pays the test under the CLFS at one national amount applicable across states and localities, without geographic adjustment or an office/facility difference. The 2026 national amount is $70.18. The physician fee schedule excludes the test, so Medicare payment is 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 87494
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 87494. 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 87494 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87494 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $70.18.
87494 on the lab fee schedule since 2026
87494 · CLFS 2026 Q4 (current)
$70.18
Unchanged since Jan 1, 2026
4 quarterly CLFS releases on file, first CLFS 2026 Q1. A code missing from a quarter wasn’t on that release.
87494 compared with similar tests
- 87491Chlamydia testAmplified nucleic acid detection$35.09
- This code represents amplified-probe testing for Chlamydia trachomatis alone. Use 87494 when one multiplex assay detects both chlamydia and gonorrhea.
- 87591Gonorrhea testAmplified DNA probe$35.09
- This code represents amplified-probe testing for Neisseria gonorrhoeae alone. Use 87494 when the laboratory performs the combined multiplex assay.
- 87490Chlamydia testDirect DNA probe$22.75
- This is a direct-probe test for Chlamydia trachomatis alone, not the combined multiplex amplified-probe test represented by 87494.
- 87492Chlamydia testQuantitative nucleic acid$53.47
- This code represents quantitative testing for Chlamydia trachomatis. Code 87494 identifies multiplex detection of chlamydia and gonorrhea.
87494 billing questions
When should this code be used instead of a single-organism assay?
Use 87494 when the performed assay detects both Chlamydia trachomatis and Neisseria gonorrhoeae using a multiplex amplified-probe method. Single-organism codes describe different assays.
What distinguishes this code from 87490?
Code 87490 describes direct-probe testing for Chlamydia trachomatis alone. Code 87494 identifies a multiplex amplified-probe test for both chlamydia and gonorrhea.
When is modifier QW appropriate?
Use QW for the CLIA-waived version when it is performed by a site holding a CLIA certificate of waiver.
How does Medicare pay this test?
Medicare pays it through the CLFS at one national amount, without geographic or office/facility adjustment. The physician fee schedule excludes the test.
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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