CPT code 87804: Influenza assay, direct visual immunoassay2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This immunoassay detects influenza virus by direct visual observation and is reported when an influenza-specific visual assay is performed.
Medicare pays $16.55 for 87804 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
$16.55
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
- QW · CLIA-waived test
- $16.55
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 87804 covers
This assay detects influenza virus using an immunoassay whose result is read by direct visual observation. It differs from a combined SARS-CoV-2 and influenza A/B visual assay, and from visual assays with RSV or SARS-CoV-2 as the target. Report 87804 when the performed test is the influenza-targeted visual immunoassay; code selection follows the assay’s target and method.
Modifier QW identifies the CLIA-waived version for performance at a site holding a CLIA certificate of waiver. Medicare pays 87804 only through the CLFS: one national amount applies in every locality, with no office-versus-facility difference. The 2026 national CLFS amount is $16.55, unchanged from 2020 through 2025. 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 87804
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 87804. 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 87804 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87804 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $16.55.
87804 on the lab fee schedule since 2020
87804 · CLFS 2026 Q4 (current)
$16.55
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.
87804 compared with similar tests
- 87812COVID and Flu TestAntigen, visual read$74.48
- 87812 is for a combined visual assay detecting SARS-CoV-2 and influenza A and B. Use 87804 for an influenza-specific assay.
- 87807RSV assayDirect visual immunoassay$13.10
- 87807 identifies RSV as the assay target; 87804 identifies influenza virus.
- 87899Antigen assayDirect visual observation$16.07
- 87899 is for an unspecified infectious-agent target. Use 87804 when the visual immunoassay specifically detects influenza.
87804 billing questions
When should this code be used instead of 87812?
Use 87804 for an influenza-specific assay read by direct visual observation. Code 87812 describes a combined visual assay for SARS-CoV-2 and influenza types A and B.
When is modifier QW relevant?
Modifier QW identifies the CLIA-waived version. It is used for that waived test at a site holding a CLIA certificate of waiver.
What does the assay detect?
It detects influenza virus by immunoassay with direct visual observation. It is not the code for an RSV, SARS-CoV-2, or unspecified-agent assay.
How does Medicare pay this test?
Medicare pays 87804 through the CLFS, with one national amount across localities and no office-versus-facility difference. It is excluded from the physician fee schedule.
Does 87804 include testing for RSV or SARS-CoV-2?
No. It describes an influenza-targeted assay; visual assays for RSV and SARS-CoV-2 have separate codes, 87807 and 87811.
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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