CPT code 87561: MAC DNA test, amplified probe detection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
An amplified nucleic acid assay detects Mycobacterium avium-intracellulare and is reported when this organism is the target of testing.
Medicare pays $35.09 for 87561 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 87561 covers
This laboratory molecular assay detects nucleic acid from Mycobacterium avium-intracellulare (MAC) using an amplified-probe method. Clinicians may order it when evaluating a patient for infection caused by this organism; the laboratory reports the result for the specific MAC target. The code describes amplified-probe detection, not a quantitative measurement and not a general test for every mycobacterium. Code choice follows the organism target and method: direct-probe MAC testing and quantitative MAC testing are represented separately.
Report 87561 for amplified-probe detection of Mycobacterium avium-intracellulare. Medicare pays this test only through the CLFS; one national amount applies across all states and localities, with no office-versus-facility payment difference. The 2026 national CLFS amount is $35.09, unchanged since 2020.
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 87561
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 87561. 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 87561 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87561 on the lab fee schedule since 2020
87561 · 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.
87561 compared with similar tests
- 87560MAC probeDirect probe method$27.29
- Both target Mycobacterium avium-intracellulare, but 87560 is for direct-probe detection and 87561 is for amplified-probe detection.
- 87562MAC DNA testQuantitative nucleic acid$42.84
- 87562 is for quantitative testing of Mycobacterium avium-intracellulare; 87561 reports amplified-probe detection.
- 87551Mycobacteria DNA testAmplified probe detection$48.24
- 87551 describes amplified-probe testing for mycobacteria more generally. Use 87561 when the assay specifically targets Mycobacterium avium-intracellulare.
- 87556TB DNA testAmplified probe$41.68
- 87556 is for amplified-probe testing of Mycobacterium tuberculosis; 87561 targets Mycobacterium avium-intracellulare.
87561 billing questions
How does 87561 differ from 87560?
87561 is for amplified-probe detection of Mycobacterium avium-intracellulare. Use 87560 when the assay uses a direct probe instead.
When is 87562 more appropriate?
87562 describes quantitative testing for Mycobacterium avium-intracellulare. Use 87561 for amplified-probe detection rather than a quantitative result.
Is 87561 the code for any mycobacterial DNA test?
No. It identifies Mycobacterium avium-intracellulare specifically. Code selection follows the organism target and method; 87551 is for amplified-probe testing of mycobacteria more generally.
What should the laboratory documentation show?
Documentation should support the organism tested and the amplified-probe method. The order and laboratory report should identify Mycobacterium avium-intracellulare as the target.
How does Medicare pay 87561?
Medicare pays it under the CLFS at one national amount across localities, with no office or facility payment difference. It is paid only through the CLFS.
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 87561 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist