CPT code 87531: HHV-6 DNA test, direct probe detection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Direct-probe nucleic acid testing detects HHV-6 DNA and is reported when this method is used rather than amplified or quantitative testing.
Medicare pays $58.00 for 87531 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
$58.00
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 87531 covers
This assay detects human herpesvirus 6 (HHV-6) DNA through a direct-probe nucleic acid method. The result indicates detection rather than a measured viral quantity. Laboratories report 87531 when this method is performed. This code distinguishes direct-probe testing from HHV-6 testing that uses an amplified probe or reports a quantitative result; those methods are represented by 87532 and 87533, respectively.
Medicare pays 87531 under the Clinical Laboratory Fee Schedule (CLFS), at one national amount applicable across states and localities, without geographic or office-versus-facility adjustment. The 2026 national CLFS amount is $58.00, unchanged from 2020 through 2026. The physician fee schedule excludes this test by statute, so Medicare payment is through the CLFS. Report 87531 for the direct-probe assay, not as a measure of viral load.
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 87531
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 87531. 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 87531 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87531 on the lab fee schedule since 2020
87531 · CLFS 2026 Q4 (current)
$58.00
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.
87531 compared with similar tests
- 87532HHV-6 DNA testAmplified probe detection$35.09
- Both test for HHV-6 DNA, but 87531 is the direct-probe method and 87532 uses an amplified probe.
- 87533HHV-6 DNAQuantitative assay$41.76
- Use 87533 when HHV-6 DNA is quantified; 87531 represents direct-probe detection.
- 87528HSV DNA testDirect probe$20.05
- 87528 detects herpes simplex virus DNA by direct probe. Select 87531 for HHV-6 and 87528 for HSV.
87531 billing questions
When should 87531 be chosen over 87532?
Choose 87531 when the HHV-6 DNA test uses a direct-probe technique. Code 87532 represents HHV-6 DNA testing by an amplified probe method.
Does 87531 report an HHV-6 viral load?
No. It represents direct-probe detection; 87533 is the quantitative HHV-6 DNA code.
How does Medicare pay for 87531?
Medicare pays the test through the CLFS using one national amount across states and localities, without an office-versus-facility difference.
Is a physician interpretation separately payable under the physician fee schedule?
No. The test is excluded from the physician fee schedule by statute and is paid through 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
Fee sheets · Coming soon
Put 87531 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist