CPT code 87812: COVID and Flu Test, antigen, visual read2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A direct-visual antigen immunoassay detects SARS-CoV-2 and influenza A and B together when evaluating suspected COVID-19 or influenza.
Medicare pays $74.48 for 87812 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
$74.48
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2026
- Unchanged
- QW · CLIA-waived test
- $74.48
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 87812 covers
Code 87812 identifies an antigen immunoassay that detects SARS-CoV-2 together with influenza A and B, using direct visual observation of the assay result. It is the combined three-target antigen test, rather than a test limited to SARS-CoV-2 or influenza alone. Clinicians use it when evaluating suspected COVID-19 and influenza in a patient with respiratory illness.
The code describes the combined test, not a separate service for each target. It differs from nucleic acid tests for the same pathogens because it uses antigen detection and a visual read. CMS recognizes a CLIA-waived version with modifier QW for testing performed by a site holding a CLIA certificate of waiver. Medicare pays 87812 only through the CLFS, at one national amount across states and localities and without an office/facility payment difference; the 2026 national amount is $74.48.
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 87812
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 87812. 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 87812 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87812 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $74.48.
87812 on the lab fee schedule since 2026
87812 · CLFS 2026 Q4 (current)
$74.48
Unchanged since Jan 1, 2026
4 quarterly CLFS releases on file, first CLFS 2026 Q1. A code missing from a quarter wasn’t on that release.
87812 compared with similar tests
- 87811COVID-19 antigenDirect visual immunoassay$41.38
- 87811 is for SARS-CoV-2 antigen detection alone. Choose 87812 when the visual antigen assay also detects influenza A and B.
- 87804Influenza assayDirect visual immunoassay$16.55
- 87804 is an influenza assay, not the combined SARS-CoV-2 and influenza A/B antigen test represented by 87812.
- 87636Respiratory testCOVID-19 and influenza A/B$142.63
- 87636 detects the same three targets by nucleic acid testing. Code 87812 is the visually read antigen immunoassay.
87812 billing questions
When should 87812 be used instead of 87811?
Use 87812 when the antigen assay detects SARS-CoV-2 and influenza A and B together. Code 87811 is for SARS-CoV-2 antigen detection without the combined influenza targets.
Does 87812 identify one target or the combined test?
It identifies the combined antigen test for SARS-CoV-2, influenza A, and influenza B.
When is modifier QW reported?
Use QW for the CLIA-waived version when testing is performed by a site holding a CLIA certificate of waiver.
Is 87812 paid under the physician fee schedule?
No. Medicare pays 87812 only through the CLFS, at one national amount across localities and practice settings.
How does 87812 differ from 87636?
Both cover SARS-CoV-2 and influenza A and B, but 87812 is an antigen immunoassay read by direct visual observation. Code 87636 describes nucleic acid detection.
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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