CPT code 87500: VRE molecular test, amplified probe2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Amplified nucleic acid testing detects vancomycin-resistance markers in Enterococcus and is reported when a laboratory performs this molecular test.
Medicare pays $35.09 for 87500 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 87500 covers
This amplified probe assay detects nucleic acid associated with vancomycin resistance in Enterococcus, including vanA- and vanB-associated resistance. Clinical laboratories perform it to detect VRE. The assay targets resistance-associated nucleic acid rather than providing a culture-based susceptibility result.
Report the service for amplified nucleic acid detection of vancomycin resistance. Medicare pays code 87500 under the CLFS at one nationally set amount, with the same amount across states and localities and no office-versus-facility difference. The 2026 national amount is $35.09, unchanged from 2020 through 2026. The test is paid through the CLFS rather than 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 87500
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 87500. 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 87500 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87500 on the lab fee schedule since 2020
87500 · 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.
87500 compared with similar tests
- 87513H. pylori resistanceClarithromycin, amplified probe$35.09
- Code 87513 detects clarithromycin resistance associated with H. pylori. Code 87500 detects vancomycin-resistance nucleic acid in Enterococcus.
- 87081Culture screenScreening only$6.63
- Code 87500 uses amplified nucleic acid detection for vancomycin resistance; 87081 describes bacterial screening by culture.
- 87186Susceptibility testMicrodilution or agar dilution$8.65
- Code 87500 detects resistance-associated nucleic acid. Code 87186 is used for antimicrobial susceptibility testing of a cultured isolate.
87500 billing questions
When should this code be selected instead of a culture-based screen?
Use this code for amplified nucleic acid detection of vancomycin resistance. A culture-based screen describes a different laboratory method.
What does the assay detect?
It detects nucleic acid associated with vancomycin resistance in Enterococcus, including vanA- and vanB-associated resistance.
Is this a susceptibility test on a cultured isolate?
No. This code describes amplified nucleic acid detection; susceptibility testing evaluates an isolate using a different method.
How does Medicare pay for this test?
Medicare pays it under the CLFS at one national amount across states and localities, without an office-versus-facility payment difference. The code is excluded from the physician fee schedule.
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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