CPT code 87799: Nucleic acid test, quantitative per organism2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Quantitative nucleic acid testing reports the amount of an infectious organism when no more specific organism-level code describes the service.
Medicare pays $42.84 for 87799 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
$42.84
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 87799 covers
87799 is used for nucleic acid testing that quantifies an infectious agent when no more specific code describes the service. The assay may detect DNA or RNA and reports a quantitative result for each organism. Code selection depends on the organism tested and whether the assay reports quantification rather than detection alone. Codes 87797 and 87798 are neighboring codes for direct-probe and amplified-probe detection, respectively.
Report one unit for each organism quantified. Medicare pays 87799 only through the CLFS. The 2026 national amount is $42.84 and has remained unchanged since 2020. The amount applies nationally, without geographic or office/facility adjustment. The test is excluded from the physician fee schedule and 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 87799
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 87799. 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 87799 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87799 on the lab fee schedule since 2020
87799 · CLFS 2026 Q4 (current)
$42.84
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.
87799 compared with similar tests
- 87797Agent detectionDirect probe, each organism$30.03
- 87797 reports infectious-agent nucleic acid detection by direct probe; 87799 reports quantification of the organism.
- 87798Infectious agent testAmplified probe, each organism$35.09
- 87798 reports infectious-agent nucleic acid detection by amplified probe. Choose 87799 when the assay quantifies the organism rather than reporting detection alone.
- 87522HCV viral loadQuantitative RNA$42.84
- 87522 specifically describes quantitative hepatitis C virus RNA testing. Use it when the test is for HCV and that code describes the assay; 87799 is the nonspecific quantitative code.
87799 billing questions
When should 87799 be selected instead of an organism-specific code?
Use 87799 when no more specific code describes the quantitative nucleic acid test for the organism and assay. For example, use the applicable specific code for quantitative hepatitis C RNA testing when it describes the service.
How many units should be reported?
Report one unit for each organism quantified.
How does 87799 differ from 87797 and 87798?
87799 describes quantification. 87797 is for direct-probe detection, while 87798 is for amplified-probe detection.
What should the laboratory documentation identify?
Documentation should support the organism tested and that the assay provides a quantitative nucleic acid result. Specimen and assay details should reflect the test performed.
How does Medicare pay 87799?
Medicare pays it through the CLFS using one national amount across localities, with no office or facility adjustment.
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 87799 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist