CPT code 87497: CMV viral load, quantitative nucleic acid test2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Quantitative nucleic acid testing measures cytomegalovirus DNA, commonly to assess viral burden and follow CMV infection in immunocompromised patients.
Medicare pays $42.84 for 87497 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
$42.84
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 87497 covers
This test detects and quantifies cytomegalovirus DNA. Clinicians commonly order it to assess CMV viremia and monitor viral burden in immunocompromised patients, including transplant recipients. Clinical laboratories perform the molecular assay and report a quantitative measurement rather than a simple detected-or-not-detected result.
Report 87497 for the quantitative CMV DNA assay, rather than a qualitative CMV detection test. The code is paid only under the Medicare CLFS. The 2026 national CLFS amount is $42.84, unchanged from 2020 through 2026; one amount applies across states and localities, with no geographic or office/facility adjustment. The physician fee schedule assigns no payment to this test. Report the service performed and the specimen tested; do not substitute a qualitative code when the laboratory reports a quantitative result.
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 87497
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 87497. 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 87497 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87497 on the lab fee schedule since 2020
87497 · CLFS 2026 Q4 (current)
$42.84
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.
87497 compared with similar tests
- 87495CMV DNA testDirect-probe detection$30.03
- 87495 is for qualitative CMV DNA detection by direct probe; 87497 is for quantifying CMV DNA.
- 87496CMV testAmplified-probe detection$35.09
- 87496 reports qualitative CMV DNA detection by an amplified probe. Choose 87497 when the assay provides a quantitative CMV DNA result.
- 87799Nucleic acid testQuantitative per organism$42.84
- 87799 is a general infectious-agent nucleic acid code for assays without a more specific code. Use 87497 for a quantitative CMV DNA assay.
87497 billing questions
When should 87497 be selected instead of 87495 or 87496?
Use 87497 when the assay quantifies CMV DNA. Codes 87495 and 87496 describe qualitative CMV DNA detection methods.
Does 87497 include a separately billable physician interpretation?
87497 is paid only under the CLFS; the physician fee schedule assigns no payment to this test.
How many units should be reported?
Report the service according to the quantitative CMV assay performed and the laboratory’s billing documentation. Multiple result values alone do not represent multiple tests.
Does Medicare pay different amounts by locality or setting?
No. Medicare pays one national CLFS amount for this code across localities, without an office-versus-facility adjustment.
What should the record support?
Documentation should identify the quantitative CMV DNA test performed and the specimen tested, and support the clinical reason for measuring CMV viral burden.
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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