CPT code 87811: COVID-19 antigen, direct visual immunoassay2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Direct-visual immunoassay detection of SARS-CoV-2 antigen is reported for testing that targets COVID-19 rather than influenza or another infectious agent.
Medicare pays $41.38 for 87811 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
$41.38
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2023
- Unchanged
- QW · CLIA-waived test
- $41.38
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 87811 covers
Code 87811 identifies an immunoassay that detects SARS-CoV-2 antigen and has a result read by direct visual observation. The method distinction matters: this code is for antigen detection, not a nucleic-acid amplification test, and it identifies SARS-CoV-2 rather than influenza A and B or an unspecified infectious agent. A combined optical-read SARS-CoV-2 and influenza A/B test is represented separately by 87812; 87804 identifies optical-read influenza testing.
Report 87811 for the SARS-CoV-2 optical-read antigen test. CMS lists modifier QW for the CLIA-waived version performed by a site holding a CLIA certificate of waiver. Medicare pays the test under the CLFS at one national amount across states and localities, without geographic or office/facility adjustment; the 2026 amount is $41.38, unchanged from 2023 through 2026. 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 87811
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 87811. 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 87811 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87811 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $41.38.
87811 on the lab fee schedule since 2021
87811 · CLFS 2026 Q4 (current)
$41.38
Unchanged since Jan 1, 2023
Every change on file
- Jan 1, 2023 · CLFS 2023 Q1MAC-priced → $41.38
24 quarterly CLFS releases on file, first CLFS 2021 Q1. A code missing from a quarter wasn’t on that release.
87811 compared with similar tests
- 87812COVID and Flu TestAntigen, visual read$74.48
- 87812 covers an optical-read test for SARS-CoV-2 plus influenza A and B; 87811 identifies the SARS-CoV-2 antigen test.
- 87804Influenza assayDirect visual immunoassay$16.55
- 87804 is an optical-read influenza assay. Use 87811 when the antigen target is SARS-CoV-2.
- 87899Antigen assayDirect visual observation$16.07
- 87899 is for optical-read testing of an unspecified infectious agent; 87811 identifies SARS-CoV-2 as the target.
87811 billing questions
When should 87811 be reported instead of 87812?
Use 87811 for the SARS-CoV-2 optical-read antigen test. Code 87812 identifies an optical-read test that also detects influenza A and B.
Does 87811 describe a molecular COVID-19 test?
No. It identifies SARS-CoV-2 antigen detection by immunoassay with direct visual observation, rather than nucleic-acid amplification.
When is modifier QW used?
CMS lists QW for the CLIA-waived version performed by a site holding a CLIA certificate of waiver.
How does Medicare pay for 87811?
Medicare pays it through the CLFS at one national amount across localities, without geographic or office/facility adjustment.
How does 87811 differ from 87899?
Code 87811 identifies SARS-CoV-2 as the target; 87899 is for optical-read testing of an unspecified infectious agent.
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
Put 87811 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet