CPT code 87636: Respiratory test, COVID-19 and influenza A/B2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Multiplex amplified-probe testing detects SARS-CoV-2 and influenza A and B nucleic acids together during evaluation of respiratory illness.
Medicare pays $142.63 for 87636 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 2022
- 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 87636 covers
This multiplex molecular assay detects nucleic acids from SARS-CoV-2 and influenza viruses A and B in a combined test. It is used in clinical evaluation when testing for these three respiratory pathogens is ordered together, rather than as separate target-specific assays. Laboratories perform and report the assay using an amplified-probe method. Code selection follows the targets included in the test performed; it is distinct from SARS-CoV-2-only testing and panels that include additional respiratory viruses.
Report the multiplex assay under 87636 rather than billing the three viral targets as separate tests. CMS lists a CLIA-waived version with modifier QW for sites holding a CLIA certificate of waiver. Medicare pays the test only through the CLFS, at one national amount across localities and without an office/facility adjustment. The 2026 national CLFS amount is $142.63, unchanged from 2022 through 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 87636
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 87636. 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 87636 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87636 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $142.63.
87636 on the lab fee schedule since 2021
87636 · CLFS 2026 Q4 (current)
$142.63
Unchanged since Jan 1, 2022
Every change on file
- Jan 1, 2022 · CLFS 2022 Q1MAC-priced → $142.63
24 quarterly CLFS releases on file, first CLFS 2021 Q1. A code missing from a quarter wasn’t on that release.
87636 compared with similar tests
- 87635COVID-19 testAmplified nucleic acid detection$51.31
- 87635 tests for SARS-CoV-2 alone by amplified-probe technique. Use 87636 when the 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. 87636 covers the first three targets without RSV.
- 87631Respiratory virus panelThree to five targets$142.63
- 87631 covers a respiratory-virus assay with 3–5 targets; 87636 identifies the SARS-CoV-2/influenza A/B combination. Select based on the assay performed.
87636 billing questions
When should 87636 be selected instead of 87635?
Use 87636 when the multiplex assay detects SARS-CoV-2 and influenza A and B. Code 87635 describes amplified-probe testing for SARS-CoV-2 alone.
Does 87636 include RSV testing?
No. This code covers SARS-CoV-2 and influenza A and B; 87637 is the related multiplex test that also includes RSV.
When is modifier QW appropriate?
Use QW for the CLIA-waived version when the performing site holds a CLIA certificate of waiver and performs the waived test.
How does Medicare pay this test?
Medicare pays 87636 under the CLFS at one national amount, with no locality or office/facility adjustment. It is paid only through the CLFS.
Should the three viral targets be billed as separate tests?
No. The multiplex assay is reported as one combined service, rather than as separate SARS-CoV-2, influenza A, and influenza B tests.
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
Fee sheets · Coming soon
Put 87636 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist