CPT code 87534: HIV-1 DNA test, direct probe detection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Direct-probe nucleic acid testing detects HIV-1 DNA and is reported when the laboratory performs this detection method.
Medicare pays $21.92 for 87534 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
$21.92
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 87534 covers
Code 87534 identifies a laboratory nucleic acid test that detects HIV-1 DNA by direct probe. It represents detection, not a quantitative viral-load result. Report it when the laboratory performs the direct-probe method. HIV-1 testing using the probe and reverse-transcription method is represented by 87535, while quantitative HIV-1 testing is represented by 87536. These codes distinguish direct detection from other HIV-1 nucleic acid testing.
Medicare pays 87534 under the CLFS at one national amount per code, applied in every locality with no geographic adjustment or office/facility difference. The 2026 national CLFS amount is $21.92 and has remained unchanged from 2020 through 2026. The test is excluded from the physician fee schedule and paid only through the CLFS.
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 87534
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 87534. 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 87534 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87534 on the lab fee schedule since 2020
87534 · CLFS 2026 Q4 (current)
$21.92
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.
87534 compared with similar tests
- 87535HIV-1 nucleic acid testAmplified probe, nonquantitative$35.09
- Choose 87534 for direct-probe detection of HIV-1 DNA. Choose 87535 when the laboratory performs the HIV-1 probe and reverse-transcription method.
- 87536HIV-1 viral loadQuantitative nucleic acid$85.10
- 87534 represents direct-probe detection; 87536 represents quantitative HIV-1 nucleic acid testing.
- 87537HIV-2 DNA testDirect probe detection$21.92
- Both codes represent direct-probe DNA detection, but 87534 is for HIV-1 and 87537 is for HIV-2.
87534 billing questions
What separates 87534 from 87535?
87534 is for direct-probe detection of HIV-1 DNA. Code 87535 represents HIV-1 testing using the probe and reverse-transcription method.
Is 87534 used for an HIV-1 viral-load result?
No. It represents direct-probe detection, while 87536 represents quantitative HIV-1 nucleic acid testing.
Which code represents direct-probe HIV-2 DNA detection?
Use 87537 for direct-probe DNA detection of HIV-2; 87534 identifies HIV-1.
How does Medicare pay for 87534?
Medicare pays the test through the CLFS using one national amount per code across localities, without an office or facility difference. It is excluded from the physician fee schedule.
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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