CPT code 87521: HCV RNA test, amplified probe2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Detects hepatitis C viral nucleic acid using an amplified probe method, typically to identify current infection after a reactive antibody screening result.
Medicare pays $35.09 for 87521 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
- QW · CLIA-waived test
- $35.09
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 87521 covers
This laboratory test detects hepatitis C virus nucleic acid using an amplified probe technique, with reverse transcription when performed. It is used to identify current HCV infection, commonly after a reactive HCV antibody screen. The specimen is typically serum or plasma. Clinical laboratories perform and report the molecular test for clinicians evaluating possible or established hepatitis C infection.
Report the test as a qualitative detection service, not as a measurement of viral load. When the CLIA-waived version is performed by a site holding a certificate of waiver, modifier QW identifies that version. Medicare pays the test from the CLFS at one national amount in every locality, without geographic or office-versus-facility adjustment; the 2026 national amount is $35.09, unchanged since 2020. The test is paid only from the CLFS, not 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 87521
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 87521. 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 87521 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87521 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $35.09.
87521 on the lab fee schedule since 2020
87521 · 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.
87521 compared with similar tests
- 87520HCV RNA testDirect probe detection$31.22
- Choose 87520 for direct-probe HCV nucleic acid detection; choose 87521 for the amplified-probe method.
- 87522HCV viral loadQuantitative RNA$42.84
- 87522 is the quantitative HCV nucleic acid test. 87521 reports detection and does not provide viral-load quantitation.
- 87516HBV DNA testAmplified probe detection$35.09
- 87516 detects hepatitis B DNA by an amplified probe method. Use 87521 when the target is hepatitis C.
87521 billing questions
How does 87521 differ from 87520?
87521 detects HCV nucleic acid using an amplified probe technique. 87520 is the direct-probe method.
When should 87522 be reported instead?
Use 87522 when the HCV nucleic acid test measures viral quantity. 87521 reports detection rather than a viral-load measurement.
When is modifier QW appropriate?
Use QW for the CLIA-waived version when the testing site holds a CLIA certificate of waiver and performs that waived test.
Can this test be reported with an HCV antibody test?
Yes. HCV antibody testing, such as 86803, may be followed by HCV nucleic acid testing to assess for current infection, including through reflex testing.
How does Medicare pay for 87521?
Medicare pays 87521 under the CLFS at one national amount that applies across localities and office and facility settings. It is paid only from the CLFS.
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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