CPT code 87535: HIV-1 nucleic acid test, amplified probe, nonquantitative2026 Medicare lab fee · Clinical Laboratory Fee Schedule
An amplified-probe HIV-1 nucleic-acid detection assay, including reverse transcription when performed, reported for detection rather than quantitative viral-load measurement.
Medicare pays $35.09 for 87535 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
- 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 87535 covers
87535 identifies an HIV-1 nucleic-acid detection assay using an amplified-probe method; reverse transcription is included when the assay performs it. It reports detection rather than quantitative HIV-1 measurement, which is represented by 87536. Within the HIV assay family, 87534 is HIV-1 direct-probe detection, while 87538 and 87539 identify HIV-2 testing. Choose the code that matches the target virus, assay method, and whether the test reports quantitative measurement.
Medicare pays 87535 only through the Clinical Laboratory Fee Schedule (CLFS); it is excluded from the physician fee schedule. The 2026 national CLFS amount is $35.09, unchanged from 2020 through 2025. CMS sets one amount for all states and localities, with no geographic adjustment or office-versus-facility difference. Report the assay code that describes the service performed; 87536 is the quantitative HIV-1 assay rather than this detection test.
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 87535
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 87535. 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 87535 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87535 on the lab fee schedule since 2020
87535 · 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.
87535 compared with similar tests
- 87534HIV-1 DNA testDirect probe detection$21.92
- Both detect HIV-1 nucleic acid, but 87534 identifies a direct-probe method. Use 87535 for the amplified-probe method.
- 87536HIV-1 viral loadQuantitative nucleic acid$85.10
- 87535 reports HIV-1 detection; 87536 reports quantitative testing used to measure HIV-1 viral load.
- 87538HIV-2 nucleic acidAmplified-probe detection$35.09
- 87538 is for HIV-2 nucleic-acid testing; 87535 targets HIV-1.
87535 billing questions
How does this code differ from 87536?
87535 reports HIV-1 nucleic-acid detection by amplified probe. Use 87536 when the assay measures HIV-1 quantitatively, such as for viral-load monitoring.
When is 87534 a closer match?
87534 describes HIV-1 detection using a direct-probe method. Select the code that matches the assay method performed.
Does the code include reverse transcription?
Yes. The reported service includes reverse transcription when the assay performs it.
Can the test be billed under the physician fee schedule?
No. Medicare pays 87535 through the CLFS; it is excluded from the physician fee schedule.
Should HIV-2 testing be reported with this code?
No. This code identifies HIV-1. HIV-2 detection uses the corresponding HIV-2 test code, such as 87538.
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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