CPT code 87528: HSV DNA test, direct probe2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reports laboratory nucleic-acid detection of herpes simplex virus DNA using a direct-probe method, distinct from amplification and quantitative HSV assays.
Medicare pays $20.05 for 87528 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
$20.05
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 87528 covers
87528 identifies laboratory nucleic-acid detection of herpes simplex virus DNA by a direct-probe method. It distinguishes this assay from HSV DNA testing that uses amplification and from quantitative HSV DNA testing. Code selection follows the assay method and result type: direct-probe detection rather than amplification or a measurement of viral quantity. The laboratory reports the result to the ordering clinician as an HSV DNA detection test.
Report 87528 for the direct-probe HSV DNA detection assay; choose the HSV amplification or quantitative code when those methods or results apply. Medicare pays it only through the CLFS. The 2026 national amount is $20.05 and has remained unchanged since 2020. The same amount applies nationwide, with no locality or office-versus-facility adjustment. The test 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 87528
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 87528. 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 87528 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87528 on the lab fee schedule since 2020
87528 · CLFS 2026 Q4 (current)
$20.05
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.
87528 compared with similar tests
- 87529HSV DNA testAmplified probe$35.09
- Both concern HSV DNA, but 87529 identifies testing by amplification. Use 87528 for direct-probe detection.
- 87530HSV DNAQuantitative viral level$42.84
- 87530 is for quantitative HSV DNA testing. Use 87528 for direct-probe detection rather than a quantitative result.
87528 billing questions
When should 87528 be used instead of 87529?
Use 87528 for HSV DNA detection by direct-probe technique. Code 87529 identifies HSV DNA testing by an amplification method.
How does 87528 differ from 87530?
87528 is for direct-probe HSV DNA detection. Code 87530 is for quantitative HSV DNA testing.
Does 87528 report a quantitative HSV DNA result?
No. It identifies direct-probe detection; quantitative HSV DNA testing is represented by 87530.
How does Medicare pay for 87528?
Medicare pays 87528 through the CLFS at one national amount, without 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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