CPT code 87806: HIV screen, visual antigen and dual antibody2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A visually read immunoassay detects HIV-1 antigen and HIV-1/HIV-2 antibodies for combined HIV screening or diagnostic evaluation.
Medicare pays $32.77 for 87806 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
$32.77
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
- $32.77
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 87806 covers
This combined HIV assay uses an immunoassay with direct visual observation to detect HIV-1 antigen together with antibodies to HIV-1 and HIV-2. It is used when a clinician needs a combined antigen-and-antibody result for HIV screening or diagnostic evaluation. The test may be performed in a physician office, clinic, or laboratory. Sites with a CLIA certificate of waiver may perform the waived version.
Report 87806 for the combined test as performed; do not split its antigen and antibody targets into separate services when they are components of this assay. Append QW for the CLIA-waived version when applicable. Medicare pays this test only under the CLFS. The 2026 national amount is $32.77, unchanged from 2020 through 2026. The amount is the same across localities, with no geographic or office/facility adjustment. The test is excluded from 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 87806
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 87806. 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 87806 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87806 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $32.77.
87806 on the lab fee schedule since 2020
87806 · CLFS 2026 Q4 (current)
$32.77
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.
87806 compared with similar tests
- 87389HIV screenHIV-1 antigen plus HIV-1/2 antibodies$24.08
- Both assays detect HIV-1 antigen and HIV-1/HIV-2 antibodies. Choose 87806 for the direct visual method; 87389 identifies the combined test using a different immunoassay method.
- 87390HIV-1 antigenAntigen only$24.06
- 87390 detects HIV-1 antigen only. Code 87806 also detects antibodies to HIV-1 and HIV-2.
- 86701HIV-1 antibodyHIV-1-specific antibody$8.89
- 86701 is an HIV-1 antibody test. Code 87806 combines HIV-1 antigen detection with antibodies to both HIV-1 and HIV-2.
- 86702HIV antibodyHIV-2-specific$13.52
- 86702 is an HIV-2 antibody test. Code 87806 combines HIV-1 antigen detection with antibodies to both HIV-1 and HIV-2.
87806 billing questions
How does 87806 differ from 87389?
Both cover HIV-1 antigen and HIV-1/HIV-2 antibodies. Code 87806 identifies a directly and visually read immunoassay; 87389 is used for the combined assay with a different method.
Should the antigen and antibody targets be billed separately?
No. Report 87806 for the combined assay rather than separating its antigen and antibody components into additional services.
When is modifier QW used?
QW identifies the CLIA-waived version for sites holding a CLIA certificate of waiver.
How does Medicare pay for 87806?
Medicare pays the test under the CLFS at one national amount that applies across localities, without an office or facility adjustment. The code is excluded from the physician fee schedule.
Can 86701 or 86702 be reported for the antibody targets?
Do not use those codes to unbundle antibody targets included in the 87806 assay. A separate antibody test is reported only when separately performed and supported.
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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