CPT code 87550: Mycobacteria test, direct probe2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A direct nucleic-acid probe test detects Mycobacteria genetic material in a patient specimen during evaluation for suspected mycobacterial infection.
Medicare pays $20.05 for 87550 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
$20.05
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 87550 covers
This laboratory molecular test detects genetic material from Mycobacteria in a patient specimen using a direct probe. It is used when the clinical question is whether the target is present, rather than how much is present. The code represents a broader Mycobacteria target; tests directed specifically to organisms such as M. tuberculosis or M. avium-intracellulare have separate codes. Clinicians may order direct molecular testing while evaluating suspected mycobacterial disease, and the laboratory reports the result to the ordering clinician.
Report this code for the direct-probe method, not an amplification or quantitative assay. The code is paid only through the Medicare Clinical Laboratory Fee Schedule (CLFS), with one national amount and no locality or office/facility payment difference. The 2026 national CLFS amount is $20.05, unchanged since 2020. The test is excluded from the physician fee schedule 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 87550
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 87550. 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 87550 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87550 on the lab fee schedule since 2020
87550 · CLFS 2026 Q4 (current)
$20.05
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.
87550 compared with similar tests
- 87551Mycobacteria DNA testAmplified probe detection$48.24
- Both test for Mycobacteria, but 87550 identifies direct-probe testing and 87551 identifies an amplification-probe method.
- 87552Mycobacteria quantificationQuantitative nucleic-acid assay$42.84
- 87550 is a direct-probe detection test; 87552 is used when the Mycobacteria assay reports a quantitative result.
- 87555TB DNA testDirect probe$26.88
- 87555 is specific to M. tuberculosis and uses a direct probe. 87550 represents the broader Mycobacteria target.
- 87560MAC probeDirect probe method$27.29
- 87560 uses a direct probe for M. avium-intracellulare specifically; 87550 is for the broader Mycobacteria target.
87550 billing questions
How does 87550 differ from 87551?
87550 identifies a direct-probe test for Mycobacteria. Use 87551 when the performed assay uses an amplification probe.
When should 87555 be used instead?
87555 is for a direct-probe assay specifically targeting M. tuberculosis. 87550 is for the broader Mycobacteria target.
Is 87550 a quantitative test?
No. It identifies direct-probe detection; 87552 is the Mycobacteria quantitative assay.
What should the laboratory record support?
The record should identify the Mycobacteria target and show that the assay performed used the direct-probe method.
How does Medicare pay for 87550?
Medicare pays it through the CLFS at one national amount. The code is excluded from the physician fee schedule by statute.
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
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