CPT code 87809: Adenovirus assay, direct visual antigen2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This direct-visual immunoassay detects adenovirus antigen, commonly in a conjunctival specimen during evaluation of suspected adenoviral conjunctivitis.
Medicare pays $21.76 for 87809 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
$21.76
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
- $21.76
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 87809 covers
Code 87809 reports a direct-visual immunoassay that detects adenovirus antigen in a patient specimen. It is commonly used as a rapid test when evaluating suspected adenoviral conjunctivitis, typically on a conjunctival specimen, and may be performed in an ophthalmology or other point-of-care setting. The assay detects antigen rather than adenovirus nucleic acid.
For Medicare, the test is paid only through the Clinical Laboratory Fee Schedule. The CLIA-waived version is identified with modifier QW and may be performed by sites holding a CLIA certificate of waiver. The 2026 national CLFS amount is $21.76, unchanged since 2020. Medicare pays one amount per code nationwide, with no locality or office-versus-facility adjustment.
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 87809
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 87809. 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 87809 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87809 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $21.76.
87809 on the lab fee schedule since 2020
87809 · CLFS 2026 Q4 (current)
$21.76
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.
87809 compared with similar tests
- 87807RSV assayDirect visual immunoassay$13.10
- Both are direct-visual immunoassays, but 87807 detects RSV; 87809 detects adenovirus.
- 87804Influenza assayDirect visual immunoassay$16.55
- Both use direct visual observation, but 87804 is for influenza antigen detection rather than adenovirus.
- 87801Multiplex NAATAmplified probes$70.20
- 87801 is a nucleic-acid amplification method for multiple agents. Choose 87809 for direct-visual adenovirus antigen detection.
87809 billing questions
When should 87809 be selected instead of a molecular adenovirus test?
Use 87809 for direct-visual immunoassay detection of adenovirus antigen. A molecular test detects nucleic acid and represents a different method.
What specimen is commonly tested with 87809?
A conjunctival specimen is commonly used when evaluating suspected adenoviral conjunctivitis.
When is modifier QW appropriate?
CMS identifies a CLIA-waived version with QW. The waived test may be performed by a site holding a CLIA certificate of waiver.
How does Medicare pay for 87809?
Medicare pays the test through the CLFS at one national amount per code, with no geographic or office-versus-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
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