CPT code 87538: HIV-2 nucleic acid, amplified-probe detection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
An amplified-probe nucleic acid assay detects HIV-2 genetic material and is reported for detection rather than quantitative viral-load measurement.
Medicare pays $35.09 for 87538 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 87538 covers
This molecular laboratory test detects HIV-2 genetic material with an amplified-probe method; reverse transcription is included when performed. The result is a detection result, not a quantitative measurement of viral nucleic acid. Clinical laboratories perform and report the assay as part of HIV-2 molecular testing. The target is HIV-2, so an HIV-1 assay is reported with the corresponding HIV-1 code.
Report 87538 for amplified HIV-2 detection; use 87537 for direct-probe detection and 87539 for quantitative testing. Medicare pays this test under the CLFS, with one national amount across states and localities and no geographic or office-versus-facility adjustment. The 2026 national CLFS amount is $35.09, unchanged from 2020 through 2026. The test is excluded from physician fee schedule payment by statute.
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 87538
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 87538. 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 87538 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87538 on the lab fee schedule since 2020
87538 · 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.
87538 compared with similar tests
- 87537HIV-2 DNA testDirect probe detection$21.92
- Both detect HIV-2 nucleic acid, but 87537 uses a direct-probe method; 87538 reports amplified-probe detection.
- 87539HIV-2 viral loadQuantitative assay$58.62
- Use 87539 when the assay quantifies HIV-2 nucleic acid. 87538 reports detection rather than a quantitative result.
- 87535HIV-1 nucleic acid testAmplified probe, nonquantitative$35.09
- 87538 targets HIV-2. Use 87535 for amplified-probe nucleic acid detection targeting HIV-1.
87538 billing questions
How does this code differ from HIV-2 quantitative testing?
This code reports amplified detection of HIV-2 nucleic acid. Use 87539 when the service measures HIV-2 nucleic acid quantitatively.
When is 87537 more appropriate?
87537 describes direct-probe detection of HIV-2 DNA. This code is for amplified-probe detection, including reverse transcription when performed.
Can this code be used for an HIV-1 assay?
No. This code identifies HIV-2; 87535 is the corresponding amplified-probe detection code for HIV-1.
How does Medicare pay for this test?
Medicare pays the test through the CLFS. The physician fee schedule lists it as excluded by statute, and the CLFS amount is the same across localities and settings.
Does this code report a viral-load result?
No. It reports amplified HIV-2 nucleic acid detection, not a quantitative viral-load measurement.
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 87538 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist