CPT code 87634: RSV test, amplified probe detection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
An amplified nucleic acid test detects respiratory syncytial virus in a respiratory specimen when clinicians evaluate suspected RSV infection.
Medicare pays $70.20 for 87634 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 2020
- Unchanged
- QW · CLIA-waived test
- $70.20
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 87634 covers
This assay detects RSV nucleic acid using an amplified-probe method. Clinicians may order it when evaluating respiratory illness and need a molecular result specifically for RSV. A respiratory specimen is tested by a clinical laboratory, including an eligible site performing the CLIA-waived version. The result identifies RSV rather than providing a broader respiratory-pathogen profile.
Report 87634 for the standalone RSV amplified-probe assay performed; use a respiratory panel code when the test is a multi-target panel, based on its target range. Report modifier QW for the CLIA-waived version performed by a site holding a CLIA certificate of waiver. Medicare pays through the CLFS only: the 2026 national amount is $70.20, unchanged each year from 2020 through 2026. The amount is the same across localities, with no geographic or office/facility adjustment. The physician fee schedule excludes the test by statute.
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 87634
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 87634. 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 87634 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87634 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $70.20.
87634 on the lab fee schedule since 2020
87634 · CLFS 2026 Q4 (current)
$70.20
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.
87634 compared with similar tests
- 87631Respiratory virus panelThree to five targets$142.63
- 87631 represents a respiratory panel testing 3–5 targets; 87634 represents an RSV-only amplified-probe assay.
- 87633Respiratory panel12–25 targets$416.78
- 87633 is for a broader respiratory panel of 12–25 targets. Use 87634 when the performed test targets RSV alone.
- 87637Respiratory testSARS-CoV-2, flu, and RSV$142.63
- 87637 detects RSV together with SARS-CoV-2 and influenza A and B; 87634 is limited to RSV.
87634 billing questions
When should 87634 be used instead of a respiratory panel code?
Use 87634 for a standalone amplified-probe test targeting RSV. When the performed assay tests multiple respiratory pathogens, select the applicable panel code based on its target range.
Does 87634 include influenza or COVID-19 testing?
No. This assay targets RSV; a multi-target test that also reports other pathogens is represented by a different code.
When is modifier QW reported?
Report QW for the CLIA-waived version when testing is performed by a site holding a CLIA certificate of waiver.
How does Medicare pay for 87634?
Medicare pays the test under the CLFS using one national amount across localities, without an office-versus-facility adjustment.
What should the record identify?
Document the respiratory specimen tested and the RSV amplified-probe assay performed, along with the result.
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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