CPT code 87552: Mycobacteria quantification, quantitative nucleic-acid assay2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reports quantitative nucleic-acid testing for Mycobacteria species, distinguishing it from probe-based assays and assays specifically targeting M. tuberculosis or M. avium-intracellulare.
Medicare pays $42.84 for 87552 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
$42.84
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 87552 covers
This test detects and quantifies nucleic acid from Mycobacteria species. It differs from direct-probe testing (87550) and amplified-probe testing (87551), as well as quantitative assays directed specifically to M. tuberculosis (87557) or M. avium-intracellulare (87562). A clinical laboratory reports 87552 when the assay provides a quantitative result for Mycobacteria species rather than one of those specifically named organisms. The method and organism targeted distinguish these neighboring codes.
Medicare pays 87552 through the Clinical Laboratory Fee Schedule (CLFS), with one national amount applying across states and localities and no office-versus-facility difference. The 2026 national CLFS amount is $42.84, 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 87552
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 87552. 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 87552 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87552 on the lab fee schedule since 2020
87552 · CLFS 2026 Q4 (current)
$42.84
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.
87552 compared with similar tests
- 87550Mycobacteria testDirect probe$20.05
- 87550 identifies direct-probe testing for Mycobacteria species. Use 87552 when the assay provides a quantitative result.
- 87551Mycobacteria DNA testAmplified probe detection$48.24
- 87551 identifies amplified-probe testing for Mycobacteria species; 87552 identifies quantitative testing.
- 87557TB DNA testQuantitative molecular assay$42.84
- Both codes identify quantitative testing, but 87557 specifically targets M. tuberculosis. Use 87552 for Mycobacteria species testing.
- 87562MAC DNA testQuantitative nucleic acid$42.84
- 87562 identifies quantitative testing specifically for M. avium-intracellulare; 87552 identifies quantitative testing for Mycobacteria species.
87552 billing questions
How does 87552 differ from 87550 and 87551?
87552 identifies quantitative testing for Mycobacteria species. Codes 87550 and 87551 identify direct-probe and amplified-probe testing, respectively.
When should 87557 be used instead?
87557 identifies quantitative testing specifically targeting M. tuberculosis. Code 87552 is for quantitative testing of Mycobacteria species.
What assay details should the documentation support?
The record should identify quantitative testing for Mycobacteria species and distinguish it from direct-probe or amplified-probe testing.
Does Medicare pay 87552 under the physician fee schedule?
No. Medicare pays this test 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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