CPT code 87536: HIV-1 viral load, quantitative nucleic acid2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Quantitative HIV-1 nucleic acid testing measures viral RNA levels, commonly to assess viral load and monitor response to antiretroviral therapy.
Medicare pays $85.10 for 87536 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
$85.10
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 87536 covers
This laboratory assay quantifies HIV-1 nucleic acid, commonly reported as a viral load from a plasma specimen. Clinicians use the result to assess HIV-1 activity and follow response to antiretroviral treatment. Hospital laboratories and independent clinical laboratories perform the testing; infectious disease and HIV care providers commonly order it for patient management.
Report the assay when HIV-1 nucleic acid is quantified, rather than when testing is limited to detection. Medicare pays this test through the CLFS, with one national amount across states and localities and no office-versus-facility payment difference. The 2026 national CLFS amount is $85.10, unchanged since 2020. The test is paid only through the CLFS, not through the physician fee schedule.
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 87536
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 87536. 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 87536 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87536 on the lab fee schedule since 2020
87536 · CLFS 2026 Q4 (current)
$85.10
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.
87536 compared with similar tests
- 87535HIV-1 nucleic acid testAmplified probe, nonquantitative$35.09
- 87535 is for HIV-1 nucleic acid detection by amplified probe; 87536 is used when the assay quantifies HIV-1.
- 87534HIV-1 DNA testDirect probe detection$21.92
- 87534 detects HIV-1 nucleic acid by direct probe. Choose 87536 when the service quantifies HIV-1 nucleic acid.
- 87539HIV-2 viral loadQuantitative assay$58.62
- 87539 quantifies HIV-2 nucleic acid. Use 87536 for quantitative HIV-1 testing.
- 87389HIV screenHIV-1 antigen plus HIV-1/2 antibodies$24.08
- 87389 is an HIV antigen-antibody screening test; 87536 measures HIV-1 nucleic acid quantitatively, commonly for viral-load monitoring.
87536 billing questions
When should this code be used instead of 87535?
Use 87536 when the HIV-1 nucleic acid test quantifies viral levels. Use 87535 when the service is HIV-1 nucleic acid detection by an amplified probe method rather than quantification.
Is this an HIV screening test?
No. This code represents quantitative HIV-1 nucleic acid testing, commonly used to measure viral load. It is distinct from HIV antigen-antibody screening.
Does this code include reverse transcription?
The service includes reverse transcription when performed.
Can the test be billed with modifier 26?
Medicare pays this test through the CLFS, not through the physician fee schedule.
Does Medicare pay different amounts by locality or setting?
No. The CLFS amount is national and applies across localities, with no office-versus-facility payment difference.
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
Put 87536 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet