CPT code 87906: HIV genotype, other genomic region2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Nucleic acid testing analyzes an HIV-1 genomic region outside reverse transcriptase, such as integrase or fusion, for genotype information.
Medicare pays $128.73 for 87906 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
$128.73
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 87906 covers
87906 represents nucleic acid-based genotype analysis of an HIV-1 region other than reverse transcriptase. Integrase and fusion are examples of regions that may be analyzed. Clinicians may order this testing as part of an HIV-1 drug-resistance assessment to help guide treatment selection. Laboratories perform the analysis and report results to clinicians managing HIV infection.
Report 87906 for analysis of the other HIV-1 region; reverse-transcriptase-region analysis is represented by a different code. Medicare pays this test through the CLFS at one national amount. The 2026 national CLFS amount is $128.73, unchanged from 2020 through 2025. The amount applies across states and localities, with no geographic or office-versus-facility adjustment. The test is 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 87906
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 87906. 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 87906 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87906 on the lab fee schedule since 2020
87906 · CLFS 2026 Q4 (current)
$128.73
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.
87906 compared with similar tests
- 87901HIV genotypeRT and protease regions$257.45
- 87901 covers HIV-1 reverse-transcriptase-region genotype analysis. 87906 is for another region, such as integrase or fusion.
- 87903HIV resistancePhenotype, first 10 drugs$488.66
- 87903 describes phenotypic HIV testing with culture. 87906 uses nucleic acid analysis to assess an HIV-1 genomic region.
- 87900Drug susceptibilityGenotype-based bioinformatics prediction$130.35
- 87900 is phenotypic infectious-agent drug-susceptibility testing. 87906 is HIV-1-specific nucleic acid genotype analysis.
87906 billing questions
When should 87906 be chosen instead of 87901?
Use 87906 for HIV-1 genotype analysis of another region, such as integrase or fusion. Use 87901 for reverse-transcriptase-region analysis.
Does 87906 describe genotypic or phenotypic testing?
It describes nucleic acid-based genotype analysis. Phenotypic drug-susceptibility testing is a different service.
Is this an HIV viral-load test?
No. This code represents analysis of HIV-1 genetic sequence in another region, not measurement of the amount of virus.
How does Medicare pay 87906?
Medicare pays it through the CLFS at one national amount, with no locality or office-versus-facility adjustment.
Can 87906 be used for HIV phenotypic testing with culture?
No. Code 87906 is for nucleic acid genotype analysis; 87903 describes a phenotypic HIV test performed 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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