CPT code 87631: Respiratory virus panel, three to five targets2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A multiplex nucleic acid test detects three to five respiratory-virus targets, including viruses such as influenza, RSV, adenovirus, or coronavirus.
Medicare pays $142.63 for 87631 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
$142.63
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
- $142.63
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 87631 covers
This molecular laboratory test uses nucleic acid detection in a multiplex assay for three to five respiratory-virus targets. Depending on the assay, targets can include influenza virus, respiratory syncytial virus, adenovirus, coronavirus, metapneumovirus, parainfluenza virus, or rhinovirus. Laboratories report the test result for the target set tested.
Report 87631 for the multiplex test covering three to five targets, not once per target. CMS recognizes a CLIA-waived version reported with modifier QW at sites holding a CLIA certificate of waiver. Medicare pays this test under the CLFS at one national amount in every state and locality, with no geographic adjustment or office/facility difference. The 2026 national amount is $142.63, unchanged since 2020. The test is excluded from the physician fee schedule by statute and paid only under 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 87631
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 87631. 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 87631 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87631 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $142.63.
87631 on the lab fee schedule since 2020
87631 · CLFS 2026 Q4 (current)
$142.63
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.
87631 compared with similar tests
- 87632Respiratory panelSix to eleven targets$218.06
- Choose 87631 for three to five respiratory-virus targets; 87632 covers six to eleven targets.
- 87633Respiratory panel12–25 targets$416.78
- Choose 87631 for three to five targets; 87633 covers a broader range of twelve to twenty-five targets.
- 87634RSV testAmplified probe detection$70.20
- 87634 is for an RSV-only nucleic acid test. Use 87631 when the assay tests three to five respiratory-virus targets.
- 87637Respiratory testSARS-CoV-2, flu, and RSV$142.63
- 87637 is the defined combination for SARS-CoV-2, influenza A/B, and RSV; 87631 applies to a multiplex assay with three to five targets when that specific combination code does not describe the test.
87631 billing questions
How does this code differ from 87632 and 87633?
The target-count range distinguishes these related multiplex respiratory-virus tests: 87631 covers three to five targets, 87632 covers six to eleven, and 87633 covers twelve to twenty-five.
Is the code reported once for each target?
No. The code represents the multiplex assay with three to five targets, not separate reporting for each target detected.
When is modifier QW appropriate?
Use QW for the CLIA-waived version when performed at a site holding a CLIA certificate of waiver.
Does Medicare pay this test under the physician fee schedule?
No. Medicare pays it under the CLFS; it is excluded from the physician fee schedule by statute.
When should a more specific respiratory-virus code be considered?
Use a code such as 87634 for an RSV-only assay or 87636 for the specified SARS-CoV-2 and influenza A/B combination when that is the test performed, rather than a broader three-to-five-target 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
Show the CMS file line behind this amount
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