CPT code 87797: Agent detection, direct probe, each organism2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A nucleic acid direct-probe test detects an infectious agent and is reported for each organism tested when no more specific code applies.
Medicare pays $30.03 for 87797 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
$30.03
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
- 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 87797 covers
This code identifies nucleic acid testing that detects an infectious agent with a direct probe. It is reported organism by organism when no more specific infectious-agent detection code describes the assay. The code is selected based on the laboratory method: direct-probe detection rather than an amplification-based method. The ordering clinician determines which organism to investigate from the clinical question, and the laboratory performs and reports the test.
Report one unit for each organism tested. Medicare pays 87797 only through the CLFS; the 2026 national amount is $30.03 and has remained unchanged from 2020 through 2026. One national amount applies in every locality, with no geographic or office-versus-facility adjustment. The test is excluded from the physician fee schedule, so payment is through the CLFS rather than a separate physician-fee-schedule payment.
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 87797
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 87797. 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 87797 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87797 on the lab fee schedule since 2020
87797 · CLFS 2026 Q4 (current)
$30.03
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.
87797 compared with similar tests
- 87798Infectious agent testAmplified probe, each organism$35.09
- 87797 is for direct-probe detection; 87798 is used when the nucleic acid detection method uses amplification.
- 87799Nucleic acid testQuantitative per organism$42.84
- 87797 identifies direct-probe detection, while 87799 is for quantitative infectious-agent detection.
- 87801Multiplex NAATAmplified probes$70.20
- 87797 is reported for each organism tested by direct probe; 87801 is for amplified-probe detection of multiple organisms.
87797 billing questions
When should 87797 be selected instead of 87798?
Use 87797 for direct-probe nucleic acid detection. Use 87798 when the detection method uses amplification.
How many units are reported?
Report one unit for each organism tested.
How does 87797 differ from 87799?
87797 identifies direct-probe detection; 87799 identifies quantitative infectious-agent detection.
How does Medicare pay for 87797?
Medicare pays it through the CLFS at one national amount per code, with no locality or office-versus-facility adjustment. It is excluded from the physician fee schedule.
Can 87797 be reported when multiple organisms are tested?
Report 87797 for each organism tested by a qualifying direct-probe method. For amplified-probe detection of multiple organisms, compare the service with 87801.
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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