CPT code 87495: CMV DNA test, direct-probe detection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Laboratory nucleic-acid testing detects cytomegalovirus DNA by direct-probe technique and is reported when that method, rather than amplification or quantification, is performed.
Medicare pays $30.03 for 87495 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
$30.03
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 87495 covers
87495 identifies cytomegalovirus (CMV) DNA using a direct-probe nucleic-acid method. The result represents detection, not a quantitative measurement of CMV DNA. This distinguishes the service from 87496, which represents CMV DNA detection by an amplified-probe method, and 87497, which represents quantitative CMV DNA testing. The laboratory method and the reported result guide selection among these related CMV tests. A clinical laboratory performs and reports the molecular test.
Report 87495 for direct-probe CMV DNA detection, not for an amplified assay or quantitative CMV result. Medicare pays this test only through the Clinical Laboratory Fee Schedule (CLFS). The 2026 national CLFS amount is $30.03 and has remained unchanged since 2020. The same amount applies across localities, with no office-versus-facility adjustment. The physician fee schedule excludes the test by statute.
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 87495
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 87495. 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 87495 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87495 on the lab fee schedule since 2020
87495 · CLFS 2026 Q4 (current)
$30.03
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.
87495 compared with similar tests
- 87496CMV testAmplified-probe detection$35.09
- Use 87495 for direct-probe CMV DNA detection; use 87496 when the laboratory performs an amplified-probe assay.
- 87497CMV viral loadQuantitative nucleic acid test$42.84
- Use 87497 when the test quantifies CMV DNA. Code 87495 represents direct-probe detection rather than a quantitative result.
87495 billing questions
How does 87495 differ from 87496?
Both detect CMV DNA, but 87495 is for the direct-probe method and 87496 is for an amplified-probe method. Select the code that matches the method performed.
When should 87497 be reported instead?
87497 describes quantitative CMV DNA testing. Use 87495 for direct-probe detection when the test is not a quantitative viral-load assay.
Does Medicare pay 87495 under the physician fee schedule?
No. Medicare pays this test through the CLFS; it is excluded from the physician fee schedule.
Does the CLFS amount vary by place of service?
No. The same national CLFS amount applies across localities and in office and facility settings.
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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