CPT code 87635: COVID-19 test, amplified nucleic acid detection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Amplified probe testing detects SARS-CoV-2 genetic material and is reported for a SARS-CoV-2-only assay rather than a combined respiratory-virus assay.
Medicare pays $51.31 for 87635 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
$51.31
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2022
- Unchanged
- QW · CLIA-waived test
- $51.31
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 87635 covers
This laboratory molecular assay detects SARS-CoV-2 DNA or RNA through an amplified probe method. It is reported for diagnostic testing when the assay targets SARS-CoV-2 alone, including during evaluation for COVID-19. Laboratories and other testing sites perform the assay; the code distinguishes it from combined assays that also detect influenza A and B or RSV.
Report this code when the assay detects SARS-CoV-2 alone; select a combined assay code when it detects additional viruses. CMS lists a QW version for testing performed by a site holding a CLIA certificate of waiver. Medicare pays 87635 through the CLFS at one national amount in all states and localities, without geographic or office-versus-facility adjustment. The 2026 national amount is $51.31, unchanged from 2022 through 2026. The service 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 87635
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 87635. 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 87635 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87635 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $51.31.
87635 on the lab fee schedule since 2020
87635 · CLFS 2026 Q4 (current)
$51.31
Unchanged since Jan 1, 2022
Every change on file
- Jan 1, 2022 · CLFS 2022 Q1MAC-priced → $51.31
26 quarterly CLFS releases on file, first CLFS 2020 Q3. A code missing from a quarter wasn’t on that release.
87635 compared with similar tests
- 87636Respiratory testCOVID-19 and influenza A/B$142.63
- 87635 detects SARS-CoV-2 alone. Use 87636 when the amplified assay also detects influenza A and B.
- 87637Respiratory testSARS-CoV-2, flu, and RSV$142.63
- 87637 includes SARS-CoV-2, influenza A and B, and RSV in one amplified assay; 87635 detects SARS-CoV-2 alone.
- 87631Respiratory virus panelThree to five targets$142.63
- 87631 describes respiratory-virus testing with 3–5 targets. 87635 is the code for an amplified assay targeting SARS-CoV-2 alone.
- 87634RSV testAmplified probe detection$70.20
- 87634 detects RSV by an amplified probe method; 87635 detects SARS-CoV-2.
87635 billing questions
When should this code be selected instead of 87636 or 87637?
Use 87635 when the assay detects SARS-CoV-2 alone. Codes 87636 and 87637 describe combined testing that also detects influenza A and B, with 87637 additionally including RSV.
Does modifier QW apply to every 87635 test?
CMS lists a QW version for the CLIA-waived test. Use QW for that version when the test is performed by a site holding a CLIA certificate of waiver.
How does Medicare pay for 87635?
Medicare pays 87635 through the CLFS at one national amount, with no geographic or office-versus-facility adjustment. The test is paid only through the CLFS.
Is this code for a respiratory virus panel?
No. It identifies amplified detection of SARS-CoV-2 alone. Codes 87631–87633 describe respiratory-virus testing by target count.
Should the code change based on the patient's symptoms?
Select the code based on what the assay detects. A combined assay that includes other viruses has a different code.
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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