CPT code 87537: HIV-2 DNA test, direct probe detection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Direct-probe nucleic acid testing detects HIV-2 DNA and is reported when the performed assay uses this detection method.
Medicare pays $21.92 for 87537 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 87537 covers
This assay detects HIV-2 DNA through a direct-probe nucleic acid method. It reports detection rather than a quantitative HIV-2 result, and is distinct from HIV-2 testing that uses probe and reverse-transcription steps. The target and method distinguish this service from nearby HIV-1 and HIV-2 nucleic acid tests. A laboratory reports the test when the performed assay is direct-probe detection of HIV-2.
Report 87537 for the performed HIV-2 direct-probe detection test. Medicare pays it through the CLFS at one national amount across states and localities, without geographic adjustment or an office-versus-facility difference. The 2026 national CLFS amount is $21.92 and has remained unchanged since 2020. The test is excluded from the physician fee schedule and is 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 87537
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 87537. 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 87537 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87537 on the lab fee schedule since 2020
87537 · 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.
87537 compared with similar tests
- 87538HIV-2 nucleic acidAmplified-probe detection$35.09
- Both test for HIV-2, but 87537 is the direct-probe DNA detection method; 87538 describes a probe and reverse-transcription method.
- 87539HIV-2 viral loadQuantitative assay$58.62
- 87539 reports quantitative HIV-2 nucleic acid testing. Choose 87537 for direct-probe detection rather than a quantitative result.
- 87534HIV-1 DNA testDirect probe detection$21.92
- Both are direct-probe DNA detection tests, but 87534 is for HIV-1 and 87537 is for HIV-2.
87537 billing questions
When should this code be chosen over 87538?
Use 87537 for direct-probe detection of HIV-2 DNA. Code 87538 describes an HIV-2 nucleic acid method that includes probe and reverse-transcription steps.
How does 87537 differ from HIV-2 quantitative testing?
87537 reports direct-probe detection, not a quantitative HIV-2 result. The HIV-2 quantitative assay is reported with 87539.
Is this the code for an HIV-1 direct-probe test?
No. 87537 is specific to HIV-2; 87534 is the corresponding direct-probe DNA detection code for HIV-1.
How does Medicare pay for this test?
Medicare pays the test through the CLFS, using one national amount across localities. It is excluded from the physician fee schedule.
Does this code include a physician interpretation?
87537 identifies the laboratory detection test and is paid through the CLFS. 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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