CPT code 87581: Mycoplasma test, amplified detection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Amplified nucleic acid testing detects Mycoplasma pneumoniae when clinicians evaluate suspected infection caused by this bacterium.
Medicare pays $35.09 for 87581 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 87581 covers
This laboratory test detects Mycoplasma pneumoniae, a bacterium, by amplifying its nucleic acid. Clinicians may order it when evaluating a suspected infection caused by this organism. The result supports identification of M. pneumoniae. This code is specific to that organism and distinguishes amplified detection from direct-probe detection and quantitative testing.
Report 87581 for amplified detection of M. pneumoniae. Medicare pays the test through the CLFS at one national amount, with no locality or office-versus-facility adjustment. The 2026 national CLFS amount is $35.09, unchanged since 2020. The test is paid through the CLFS, not 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 87581
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 87581. 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 87581 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87581 on the lab fee schedule since 2020
87581 · 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.
87581 compared with similar tests
- 87580Mycoplasma testDirect probe$20.05
- Use 87580 for direct-probe detection of M. pneumoniae. Use 87581 when the method amplifies the target nucleic acid.
- 87582Mycoplasma testQuantitative nucleic acid$302.62
- Use 87582 when the assay provides a quantitative M. pneumoniae result; 87581 represents amplified detection.
- 87563M. genitalium testAmplified nucleic acid probe$35.09
- 87563 detects M. genitalium, whereas 87581 detects M. pneumoniae. Choose based on the organism tested.
87581 billing questions
How does this code differ from 87580?
Both detect Mycoplasma pneumoniae, but 87581 represents amplified detection and 87580 represents direct-probe detection. Choose the code that matches the method performed.
When would 87582 be reported instead?
87582 is for quantitative testing of M. pneumoniae. Use 87581 for amplified detection rather than a quantitative result.
How does 87581 differ from 87563?
87581 detects M. pneumoniae; 87563 detects M. genitalium. Select the code for the organism tested.
Is there a separately payable physician interpretation?
The test is paid through the CLFS and is excluded from the physician fee schedule.
Does Medicare payment vary by locality or setting?
No. The CLFS amount is national and has no geographic or office-versus-facility adjustment.
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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