CPT code 87516: HBV DNA test, amplified probe detection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
87516 reports amplified-probe nucleic acid detection of hepatitis B virus DNA when a qualitative HBV DNA result, rather than a viral quantity, is needed.
Medicare pays $35.09 for 87516 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 87516 covers
87516 identifies hepatitis B virus DNA with an amplified-probe nucleic acid method. It is a qualitative detection service: the result indicates whether HBV DNA is detected, rather than reporting its amount. It is distinct from hepatitis B antigen and antibody tests, which assess viral proteins or the patient's immune response. Clinical laboratories report the assay when HBV DNA detection is requested.
Report 87516 for amplified-probe detection, not quantitative HBV DNA measurement; 87517 identifies quantitative HBV DNA testing. Medicare pays 87516 only through the Clinical Laboratory Fee Schedule (CLFS). The CLFS amount is nationally set and is the same across states and localities, without an office-versus-facility payment difference. The 2026 national CLFS amount is $35.09, unchanged from 2020 through 2026. The test is excluded from physician fee schedule payment.
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 87516
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 87516. 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 87516 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87516 on the lab fee schedule since 2020
87516 · 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.
87516 compared with similar tests
- 87517HBV viral loadQuantitative DNA test$42.84
- 87516 detects HBV DNA; 87517 reports a quantitative HBV DNA result.
- 87340HBsAg testSurface antigen immunoassay$10.33
- 87340 tests for hepatitis B surface antigen, while 87516 detects HBV DNA.
- 86704Core antibodyTotal antibody$12.05
- 86704 tests for hepatitis B core antibodies; 87516 detects viral DNA.
87516 billing questions
When should 87516 be reported instead of 87517?
Use 87516 for amplified-probe detection of HBV DNA. Use 87517 when the service measures the amount of HBV DNA.
Is 87516 an HBV antibody or antigen test?
No. It detects hepatitis B viral DNA; antigen and antibody tests measure different markers.
Does Medicare pay 87516 through the CLFS?
Yes. Medicare pays it only through the CLFS, using one national amount across localities and settings.
Is modifier 26 appropriate for 87516?
No. Medicare pays 87516 only through the CLFS; the test is excluded from physician fee schedule payment.
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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