CPT code 87522: HCV viral load, quantitative RNA2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Quantitative HCV RNA testing measures viral concentration in a specimen and is reported when the assay determines hepatitis C viral load.
Medicare pays $42.84 for 87522 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
$42.84
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 87522 covers
This assay measures the amount of hepatitis C virus RNA in a specimen, using reverse transcription when performed. Serum or plasma is commonly tested. Clinicians use quantitative HCV RNA results to assess viral levels and monitor response to treatment. Testing is generally performed by a clinical laboratory and may be ordered by the clinician managing the patient’s hepatitis C care.
Report this code when the assay quantifies HCV RNA; the result expresses viral concentration rather than only a positive-or-negative finding. Medicare pays the test only under the CLFS. The 2026 national CLFS amount is $42.84, unchanged since 2020. The same amount applies across localities, with no geographic or office-versus-facility adjustment.
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 87522
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 87522. 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 87522 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87522 on the lab fee schedule since 2020
87522 · CLFS 2026 Q4 (current)
$42.84
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.
87522 compared with similar tests
- 87520HCV RNA testDirect probe detection$31.22
- 87520 reports direct-probe detection of HCV nucleic acid. Use 87522 when the test quantifies HCV RNA.
- 87521HCV RNA testAmplified probe$35.09
- 87521 is a nonquantitative HCV nucleic acid assay. Use 87522 when the laboratory reports an RNA quantity.
- 87517HBV viral loadQuantitative DNA test$42.84
- 87517 quantifies hepatitis B DNA; 87522 quantifies hepatitis C RNA. Select the code for the virus tested.
87522 billing questions
When should this code be used instead of 87521?
Use 87522 when the assay quantifies HCV RNA. Code 87521 describes HCV nucleic acid testing without quantification.
How does this differ from 87520?
Code 87520 is for direct-probe HCV nucleic acid detection. Code 87522 reports quantitative HCV RNA testing.
What should the documentation support?
The order and laboratory record should identify a quantitative HCV RNA assay, with a result expressing viral concentration.
Does this code report a positive-or-negative HCV result?
It reports quantitative HCV RNA testing, which measures viral concentration rather than only a positive-or-negative finding.
How does Medicare pay this test?
Medicare pays it under the CLFS at one national amount per code, with no locality or office-versus-facility adjustment.
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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