CPT code 87496: CMV test, amplified-probe detection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reports laboratory detection of cytomegalovirus nucleic acid using an amplified-probe method, distinguishing it from direct-probe detection and quantitative measurement.
Medicare pays $35.09 for 87496 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 87496 covers
87496 identifies laboratory testing that detects cytomegalovirus (CMV) nucleic acid with an amplified-probe method. It is the method-specific code for CMV detection, rather than a code for direct-probe detection or quantitative CMV measurement. The result indicates whether CMV nucleic acid is detected; it does not represent a quantitative viral-load result. Clinical laboratories report this molecular test when the service performed is amplified-probe CMV detection.
Report 87496 for the amplified-probe assay, 87495 for direct-probe CMV detection, and 87497 for quantitative CMV testing. The Medicare CLFS pays one national amount per code in every state and locality, without geographic or office/facility adjustment. The 2026 national CLFS amount is $35.09, unchanged from 2020 through 2025. Medicare pays the test through the CLFS; it is excluded from the physician fee schedule 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 87496
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 87496. 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 87496 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87496 on the lab fee schedule since 2020
87496 · 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.
87496 compared with similar tests
- 87495CMV DNA testDirect-probe detection$30.03
- Choose 87496 for amplified-probe CMV detection; 87495 identifies CMV detection using a direct-probe method.
- 87497CMV viral loadQuantitative nucleic acid test$42.84
- Choose 87496 for amplified-probe CMV detection. Use 87497 when the laboratory assay quantitates CMV nucleic acid.
87496 billing questions
What separates 87496 from 87495?
87496 is for amplified-probe CMV nucleic acid detection. Code 87495 is for direct-probe CMV detection.
Does 87496 report a CMV viral load?
No. It reports amplified-probe detection; use 87497 for quantitative CMV nucleic acid testing.
How does Medicare pay for 87496?
Medicare pays it through the CLFS at one national amount across localities, without an office or facility adjustment.
Is 87496 paid under the physician fee schedule?
No. Medicare pays this test through the CLFS; it is excluded from the physician fee schedule by statute.
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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