CPT code 87563: M. genitalium test, amplified nucleic acid probe2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Detects Mycoplasma genitalium genetic material with an amplified probe, often during evaluation of persistent or recurrent urethritis or cervicitis.
Medicare pays $35.09 for 87563 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
- QW · CLIA-waived test
- $35.09
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 87563 covers
This molecular assay detects genetic material from Mycoplasma genitalium using an amplified DNA or RNA probe. Clinicians may order it when evaluating persistent or recurrent nongonococcal urethritis or cervicitis; testing may also be considered during evaluation of pelvic inflammatory disease. Laboratories and qualified testing sites perform the assay using a specimen supported by the test method.
Report 87563 for amplified-probe detection of M. genitalium, not for a different organism or a quantitative result. CMS lists a QW version for testing performed by a site holding a CLIA certificate of waiver. Medicare pays the test through the CLFS at one national amount; the 2026 amount is $35.09, unchanged from 2020 through 2026, with no locality or office/facility adjustment. The physician fee schedule excludes the test, so it has no separate payment there.
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 87563
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 87563. 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 87563 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87563 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $35.09.
87563 on the lab fee schedule since 2020
87563 · 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.
87563 compared with similar tests
- 87591Gonorrhea testAmplified DNA probe$35.09
- 87591 detects Neisseria gonorrhoeae by an amplified probe; 87563 detects Mycoplasma genitalium. Select based on the organism tested.
- 87491Chlamydia testAmplified nucleic acid detection$35.09
- 87491 detects Chlamydia trachomatis by an amplified probe. It is not a substitute for M. genitalium testing.
- 87581Mycoplasma testAmplified detection$35.09
- 87581 detects Mycoplasma pneumoniae, a different species associated with respiratory infection. Use 87563 for M. genitalium.
87563 billing questions
When should 87563 be selected instead of a gonorrhea or chlamydia test?
Use 87563 for amplified-probe detection of Mycoplasma genitalium. Gonorrhea and chlamydia tests identify different organisms and are reported with their respective codes.
Can 87563 be reported with chlamydia and gonorrhea testing?
Yes, when each distinct test is performed and documented. The codes identify separate organisms, even when the tests are ordered during the same STI evaluation.
When is modifier QW appropriate?
Use QW for the CLIA-waived version when the testing site holds a CLIA certificate of waiver and performs the waived test.
Does Medicare pay 87563 differently in an office and a facility?
No. Medicare pays it through the CLFS at one national amount, without locality or office-versus-facility variation.
What should the record support for 87563?
Document the clinical reason for testing, the specimen tested, and the result of the M. genitalium amplified-probe assay.
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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