CPT code 87803: C. difficile toxin, direct visual immunoassay2026 Medicare lab fee · Clinical Laboratory Fee Schedule
87803 reports an immunoassay for Clostridium difficile toxin A that is read by direct visual observation.
Medicare pays $16.00 for 87803 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
$16.00
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 87803 covers
Code 87803 identifies an immunoassay that detects Clostridium difficile toxin A and is read by direct visual observation. The target and readout distinguish this service from nucleic acid testing and assays for other infectious agents. Report the code when the performed test is this toxin A immunoassay; the code describes the assay method and target, rather than a broader multi-agent molecular test.
Medicare pays 87803 through the CLFS. The 2026 national amount is $16.00 and has remained $16.00 in each year from 2020 through 2026. This single national amount applies in every state and locality, with no geographic adjustment or office-versus-facility difference. Medicare pays the test only from the CLFS, not the physician fee schedule.
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 87803
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 87803. 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 87803 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87803 on the lab fee schedule since 2020
87803 · CLFS 2026 Q4 (current)
$16.00
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.
87803 compared with similar tests
- 87899Antigen assayDirect visual observation$16.07
- 87803 identifies Clostridium difficile toxin A. 87899 is for direct visual infectious-agent detection when the agent is unspecified.
- 87800Direct-probe testMultiple organisms$43.67
- 87800 describes direct nucleic acid detection of multiple agents; 87803 detects Clostridium difficile toxin A by immunoassay with visual observation.
- 87801Multiplex NAATAmplified probes$70.20
- 87801 describes amplified nucleic acid detection of multiple agents. 87803 is for the toxin A immunoassay read by direct visual observation.
87803 billing questions
Which test method qualifies for 87803?
The test must be an immunoassay for Clostridium difficile toxin A read by direct visual observation.
How does 87803 differ from molecular testing?
87803 identifies toxin A by immunoassay with direct visual observation. A nucleic acid test uses a different method and should be coded for the assay performed.
How does Medicare pay for 87803?
Medicare pays it through the CLFS at one national amount across states and localities, with no office-versus-facility difference. It is paid only from the CLFS, not the physician fee schedule.
What should the laboratory record support?
It should support that the reported test was an immunoassay for toxin A read by direct visual observation.
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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