CPT code 87498: Enterovirus test, amplified detection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
An amplified nucleic acid assay detects enterovirus, commonly in cerebrospinal fluid during evaluation of suspected viral meningitis or encephalitis.
Medicare pays $35.09 for 87498 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 87498 covers
This molecular assay detects enterovirus nucleic acid through amplification, with reverse transcription when performed. Clinicians commonly order it on cerebrospinal fluid when evaluating suspected viral meningitis or encephalitis. Hospital and reference laboratories perform the test. Report it for an enterovirus-specific assay rather than for a multiplex CNS pathogen panel or a test directed at another organism. It reports detection, not a quantitative viral load.
Medicare pays the code only through the CLFS. The 2026 national CLFS amount is $35.09 and has remained unchanged since 2020. The same amount applies nationwide, with no locality or office-versus-facility adjustment. The code is excluded from the physician fee schedule.
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 87498
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 87498. 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 87498 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87498 on the lab fee schedule since 2020
87498 · 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.
87498 compared with similar tests
- 87483CNS pathogen panel12–25 CNS targets$416.78
- 87483 represents a multiplex CNS pathogen panel. Use 87498 for a standalone amplified enterovirus assay.
- 87798Infectious agent testAmplified probe, each organism$35.09
- 87498 identifies enterovirus specifically; 87798 is for an amplified infectious-agent assay when no more specific code describes the target.
- 87496CMV testAmplified-probe detection$35.09
- 87496 is an amplified nucleic acid test for cytomegalovirus. Select the code for the organism tested: enterovirus for 87498 or cytomegalovirus for 87496.
87498 billing questions
When is this code used instead of a CNS pathogen panel code?
Use this code for an amplified nucleic acid assay directed at enterovirus. Code 87483 represents a multiplex CNS pathogen panel.
Does this test measure enterovirus viral load?
No. It reports enterovirus detection by an amplified nucleic acid method, not a quantitative viral load.
What specimen is commonly tested?
Cerebrospinal fluid is commonly tested when clinicians evaluate suspected viral meningitis or encephalitis.
How does Medicare pay this code?
Medicare pays it through the CLFS at one national amount per code, with no locality or office-versus-facility adjustment.
How does this code differ from 87798?
87498 identifies enterovirus as the target. Code 87798 is used for an amplified infectious-agent assay when no more specific code describes the target.
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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