CPT code 87520: HCV RNA test, direct probe detection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Detects hepatitis C virus RNA by direct probe and is reported when the laboratory performs this nucleic acid detection method.
Medicare pays $31.22 for 87520 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
$31.22
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 87520 covers
This laboratory assay detects hepatitis C virus RNA by a direct-probe nucleic acid method. It reports detection rather than a quantitative viral-load result. Code selection follows the assay method: 87520 identifies direct-probe detection, while nearby HCV RNA codes distinguish reverse-transcription probe methods or quantitative testing. An HCV antibody test measures a different marker and does not detect viral RNA. The code describes the laboratory method and result type, not a specific patient history or treatment stage.
Medicare pays 87520 through the CLFS only. The 2026 national CLFS amount is $31.22, unchanged from 2020 through 2026; one amount applies nationwide, without locality or office-versus-facility adjustment. The code 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 87520
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 87520. 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 87520 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87520 on the lab fee schedule since 2020
87520 · CLFS 2026 Q4 (current)
$31.22
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.
87520 compared with similar tests
- 87521HCV RNA testAmplified probe$35.09
- 87521 identifies an HCV probe method with reverse transcription; 87520 identifies direct-probe detection. Select according to the method performed.
- 87522HCV viral loadQuantitative RNA$42.84
- 87522 is used for quantitative HCV testing, while 87520 describes direct-probe detection rather than a quantitative viral-load result.
- 86803Hepatitis C antibodyScreening antibody assay$14.27
- 86803 detects HCV antibody, whereas 87520 detects HCV RNA. Choose according to whether the test measures antibody or viral RNA.
87520 billing questions
When is 87520 used instead of 87521?
Use 87520 for direct-probe HCV RNA detection. Code 87521 identifies an HCV probe method with reverse transcription.
How does 87520 differ from 87522?
87520 describes direct-probe detection. Code 87522 is used for quantitative HCV testing.
How does this test differ from HCV antibody testing?
This assay detects HCV RNA; an antibody test detects the patient's immune response to HCV. The codes describe different tests.
How does Medicare pay for 87520?
Medicare pays the test through the CLFS. The national amount applies across localities and in office and facility settings.
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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