CPT code 87580: Mycoplasma test, direct probe2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Direct-probe nucleic acid testing detects Mycoplasma pneumoniae and is reported when the laboratory tests for this organism using that method.
Medicare pays $20.05 for 87580 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 87580 covers
This laboratory test detects Mycoplasma pneumoniae nucleic acid by direct probe. It supports evaluation for infection caused by this bacterium when the clinician includes M. pneumoniae in the differential diagnosis. The result is organism-specific; it does not represent a broad respiratory pathogen screen. Choose this code for the direct-probe method, not amplification or quantitative testing. The laboratory result is reported to the ordering clinician.
Medicare pays 87580 through the CLFS, with one amount per code applying across states and localities and no office-versus-facility difference. The 2026 national CLFS amount is $20.05, unchanged from 2020 through 2025. The code 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 87580
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 87580. 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 87580 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87580 on the lab fee schedule since 2020
87580 · 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.
87580 compared with similar tests
- 87581Mycoplasma testAmplified detection$35.09
- Both target Mycoplasma pneumoniae, but 87580 is the direct-probe test and 87581 uses an amplification probe.
- 87582Mycoplasma testQuantitative nucleic acid$302.62
- 87580 detects the organism by direct probe; 87582 reports a quantitative result.
- 87540Legionella DNADirect-probe detection$20.05
- 87540 detects Legionella pneumophila by direct probe. Select 87580 when the target is Mycoplasma pneumoniae.
87580 billing questions
When should 87580 be selected instead of 87581?
Use 87580 for direct-probe detection of Mycoplasma pneumoniae. Code 87581 describes an amplification probe test for the same organism.
How does 87580 differ from 87582?
87580 is for direct-probe detection. 87582 is the quantitative test for Mycoplasma pneumoniae.
Does Medicare pay 87580 under the physician fee schedule?
No. Medicare pays this test through the CLFS only, using one national amount across localities and settings.
What organism does 87580 identify?
It detects Mycoplasma pneumoniae nucleic acid. It is not a test for Legionella or other respiratory pathogens.
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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