CPT code 87899: Antigen assay, direct visual observation2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reports an infectious-agent antigen immunoassay read by direct visual observation when no more specific code describes the organism tested.
Medicare pays $16.07 for 87899 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
$16.07
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
- $16.07
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 87899 covers
Laboratories and office-based testing sites use this code to report antigen detection for an infectious agent using immunoassay, with the result read by direct visual observation. It is the nonspecific choice when no more specific code identifies the organism-specific assay performed; named-agent codes apply when their target matches. The method distinguishes this service from nucleic-acid detection. Medicare recorded 11,847 office services and no facility services in 2024.
Report the test performed under 87899 rather than a more specific code that identifies the organism tested. CMS lists QW for the CLIA-waived version, which sites holding a CLIA certificate of waiver may perform. Medicare pays the test only through the CLFS, at one national amount per code across localities and without an office-versus-facility adjustment. The 2026 national amount is $16.07, unchanged since 2020. The test has no physician fee schedule payment.
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 87899
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 87899. 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 87899 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 87899 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $16.07.
87899 on the lab fee schedule since 2020
87899 · CLFS 2026 Q4 (current)
$16.07
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.
87899 compared with similar tests
- 87804Influenza assayDirect visual immunoassay$16.55
- 87804 is the direct-visual assay code for influenza. Use 87899 when the organism is not represented by a more specific code.
- 87880Rapid strep testGroup A antigen, visual$16.53
- 87880 identifies a direct-visual group A streptococcus assay. Code 87899 is for another infectious agent without a more specific code.
- 87801Multiplex NAATAmplified probes$70.20
- 87801 is for detecting multiple agents by nucleic-acid amplification. Code 87899 describes antigen detection by immunoassay with direct visual observation.
87899 billing questions
When should 87899 be used instead of a named-agent assay code?
Use 87899 for an infectious-agent antigen immunoassay read by direct visual observation when no more specific code describes the organism. Use a named-agent code when it matches the test performed.
When is modifier QW appropriate?
CMS lists QW for the CLIA-waived version of this test. Sites holding a CLIA certificate of waiver may perform that version.
Does 87899 describe antigen or nucleic-acid testing?
It describes antigen detection by immunoassay with direct visual observation. Nucleic-acid amplification is a different testing method.
How does Medicare pay 87899?
Medicare pays the test through the CLFS at one national amount per code, with no locality or office-versus-facility adjustment. It has no physician fee schedule payment.
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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