CPT code 87901: HIV genotype, RT and protease regions2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This nucleic-acid test analyzes HIV-1 reverse transcriptase and protease regions for genetic variation associated with antiretroviral resistance and treatment decisions.
Medicare pays $257.45 for 87901 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
$257.45
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 87901 covers
87901 identifies nucleic-acid genotypic analysis of HIV-1 in the reverse transcriptase and protease regions. Clinical laboratories perform the analysis to characterize viral genetic variation in those regions associated with antiretroviral resistance and to inform treatment selection or adjustment. This genotype assay is distinct from phenotypic HIV drug-susceptibility testing, such as the culture-based service represented by 87903. Code 87906 represents HIV-1 genotypic analysis outside the regions specified for 87901.
Report 87901 for this HIV-1 analysis of the reverse transcriptase and protease regions. Medicare pays it only through the CLFS, at one nationally set amount across states and localities, without an office-versus-facility difference. The 2026 national CLFS amount is $257.45, unchanged since 2020. The test is excluded from the physician fee schedule.
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 87901
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 87901. 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 87901 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87901 on the lab fee schedule since 2020
87901 · CLFS 2026 Q4 (current)
$257.45
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.
87901 compared with similar tests
- 87906HIV genotypeOther genomic region$128.73
- 87901 analyzes HIV-1 reverse transcriptase and protease regions. 87906 represents genotypic analysis of other HIV-1 region or regions.
- 87903HIV resistancePhenotype, first 10 drugs$488.66
- 87901 is nucleic-acid genotype analysis. 87903 represents phenotypic HIV testing performed with culture.
- 87902Hepatitis C genotypeNucleic acid analysis$257.45
- Both are nucleic-acid genotype tests, but 87901 targets HIV-1 reverse transcriptase and protease regions, while 87902 targets hepatitis C.
87901 billing questions
When is 87901 the appropriate HIV resistance test?
Use it for nucleic-acid genotype analysis of HIV-1 reverse transcriptase and protease regions. A phenotypic susceptibility assay is a different service.
How does 87901 differ from 87906?
87901 identifies the reverse transcriptase and protease regions. 87906 represents genotypic analysis of other HIV-1 region or regions.
Can 87901 be used for hepatitis C genotyping?
No. 87901 is specific to HIV-1; 87902 is the nucleic-acid genotype analysis code for hepatitis C.
Does Medicare pay 87901 under the physician fee schedule?
No. Medicare pays this test through the CLFS, with the same amount across localities and office and facility settings.
Is 87901 a phenotypic resistance test?
No. It analyzes HIV-1 genetic variation in the reverse transcriptase and protease regions; 87903 represents phenotypic HIV testing with culture.
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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