CPT code 87560: MAC probe, direct probe method2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This direct-probe test detects Mycobacterium avium-intracellulare nucleic acid and is reported for organism-specific MAC testing.
Medicare pays $27.29 for 87560 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
$27.29
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 87560 covers
This molecular laboratory test detects Mycobacterium avium-intracellulare (MAC) nucleic acid by a direct probe. Microbiology laboratories perform or report it as an organism-specific identification test in diagnostic workups for suspected MAC infection. It differs from assays directed at mycobacteria more broadly and from MAC assays that use an amplified probe or provide a quantitative result. The method identifies the target; it is not a culture service.
Report 87560 when the MAC direct-probe assay is performed, rather than for culture, amplified-probe detection, or quantitative testing. Medicare pays this test through the CLFS at one national amount across states and localities, with no geographic or office-versus-facility adjustment. The 2026 national amount is $27.29, unchanged from 2020 through 2026. The code is paid only through the CLFS and is excluded from 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 87560
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 87560. 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 87560 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87560 on the lab fee schedule since 2020
87560 · CLFS 2026 Q4 (current)
$27.29
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.
87560 compared with similar tests
- 87561MAC DNA testAmplified probe detection$35.09
- Both target MAC, but 87560 uses a direct probe and 87561 uses an amplified probe.
- 87562MAC DNA testQuantitative nucleic acid$42.84
- 87560 detects MAC by direct probe; 87562 is for quantitative MAC nucleic acid testing.
- 87550Mycobacteria testDirect probe$20.05
- 87550 is a direct-probe test for mycobacteria more broadly; 87560 targets MAC.
- 87555TB DNA testDirect probe$26.88
- 87555 targets Mycobacterium tuberculosis by direct probe, while 87560 targets MAC.
87560 billing questions
When should this code be chosen instead of 87561?
Use 87560 for MAC detection by direct probe. Code 87561 describes MAC detection by an amplified probe.
Does 87560 describe a culture?
No. It reports a direct-probe test for MAC nucleic acid, not a culture service.
How does 87560 differ from 87562?
87560 is the direct-probe method. Code 87562 is for quantitative MAC nucleic acid testing.
How does Medicare pay for this test?
Medicare pays it through the CLFS. The code is excluded from the physician fee schedule.
Does payment vary by locality or by office versus facility?
No. Medicare applies one national CLFS amount across states and localities, without an office-versus-facility 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
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