CPT code 87900: Drug susceptibility, genotype-based bioinformatics prediction2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reports a bioinformatics analysis that predicts an infectious agent’s drug susceptibility from its genotype to help guide antimicrobial treatment selection.
Medicare pays $130.35 for 87900 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
$130.35
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
- CMS updates
- Quarterly
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 87900 covers
This service uses genotypic information and bioinformatics to predict an infectious agent’s likely drug susceptibility. The result is a predicted susceptibility profile, not a direct measurement of the organism’s response to drugs in culture. Clinical laboratories perform and report the analysis for clinicians evaluating antimicrobial treatment options or resistance. The reported service is the bioinformatics-based susceptibility prediction, rather than a standalone genotypic analysis or cultured-organism susceptibility assay.
Report the bioinformatics-based susceptibility prediction, not a standalone genotypic analysis or cultured-organism susceptibility assay. Medicare pays 87900 only through the Clinical Laboratory Fee Schedule (CLFS), at one national amount that applies across states and localities, without geographic or office-versus-facility adjustment. The 2026 national CLFS amount is $130.35, unchanged from 2020 through 2026. The code 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 87900
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 87900. 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 87900 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87900 on the lab fee schedule since 2020
87900 · CLFS 2026 Q4 (current)
$130.35
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.
87900 compared with similar tests
- 87901HIV genotypeRT and protease regions$257.45
- 87901 reports HIV-1 genotypic analysis focused on reverse transcriptase. Use 87900 for the bioinformatics-based drug susceptibility prediction service.
- 87903HIV resistancePhenotype, first 10 drugs$488.66
- 87903 is HIV-1 phenotypic susceptibility testing using cultured virus. Code 87900 reports a genotype-based prediction rather than culture-based measurement.
- 87906HIV genotypeOther genomic region$128.73
- 87906 reports HIV-1 genotypic analysis. Code 87900 is distinguished by predicting drug susceptibility from genotypic information using bioinformatics.
87900 billing questions
How is this different from a cultured-virus susceptibility test?
87900 reports drug-response prediction from genetic information and bioinformatics. Code 87903 describes HIV phenotypic susceptibility testing using cultured virus.
Is this a genotypic resistance test or a phenotype test?
It reports a predicted phenotype based on genotype analysis. It does not describe direct drug-susceptibility measurement in culture.
What should the record support?
Document the infectious-agent drug susceptibility prediction performed and its clinical context, such as treatment selection or resistance assessment.
Can a physician bill modifier 26 for interpretation?
Medicare pays 87900 only through the CLFS; it is excluded from the physician fee schedule.
How does Medicare pay this code?
Medicare pays one national CLFS amount per code, with the same amount across localities and office or facility settings.
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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