CPT code 87626: HPV test, separate types and pooled results2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Nucleic acid testing for high-risk HPV with selected types reported separately and pooled results reported together for clinical HPV testing.
Medicare pays $70.20 for 87626 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
$70.20
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2025
- 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 87626 covers
87626 represents nucleic acid detection of human papillomavirus with selected high-risk types reported separately and high-risk result(s) also reported as pooled. This result format distinguishes the assay from testing that reports only pooled high-risk results or reports types 16 and 18 only. It is used in clinical HPV testing, including cervical screening and evaluation of abnormal screening results; a clinical laboratory performs and reports the assay.
Medicare pays this test only through the CLFS; it is excluded from the physician fee schedule. CLFS pricing is national, with one amount applying in every state and locality and no geographic or office-versus-facility adjustment. The 2026 national CLFS amount is $70.20, unchanged from 2025.
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 87626
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 87626. 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 87626 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87626 on the lab fee schedule since 2025
87626 · CLFS 2026 Q4 (current)
$70.20
Unchanged since Jan 1, 2025
8 quarterly CLFS releases on file, first CLFS 2025 Q1. A code missing from a quarter wasn’t on that release.
87626 compared with similar tests
- 87624High-risk HPVPooled result$35.09
- Code 87624 reports pooled high-risk HPV result(s). Use 87626 when selected high-risk types are reported individually along with pooled result(s).
- 87625HPV genotypingTypes 16 and 18$40.55
- Code 87625 is limited to HPV types 16 and 18. Code 87626 represents selected separately reported high-risk types plus pooled result(s).
- 87623Low-risk HPVNucleic acid detection$35.09
- Code 87623 tests for low-risk HPV types. Code 87626 concerns high-risk HPV results, including separately reported types and pooled result(s).
87626 billing questions
When should this code be used instead of 87624?
Use 87626 when selected high-risk HPV types are reported separately along with pooled high-risk result(s). Code 87624 represents pooled high-risk results.
How does this code differ from 87625?
Code 87625 is for testing limited to HPV types 16 and 18. Code 87626 represents selected separately reported high-risk types along with pooled high-risk result(s).
Does this code represent both individual and pooled results?
Yes. The assay reports selected high-risk types separately and also reports high-risk result(s) as pooled.
How does Medicare pay for this test?
Medicare pays it through the CLFS at one national amount that applies across states and localities, without an 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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