87798 Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for Detect agent nos dna amp.
National Average Payment
Non-Facility (Private Office) Rate
87798 Reimbursement Rate History
| Quarter | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 | Q3 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $35.09 | $35.09 | $35.09 | $35.09 | $35.09 | $35.09 |
ℹ️ Good to Know
This item has a standard price nationwide. Your local rate will likely match the amount shown above.
Code Description
Infectious agent detection by nucleic acid (dna or rna), not otherwise specified; amplified probe technique, each organism
Reimbursement Summary
CPT code 87798 (Infectious agent detection by nucleic acid (dna or rna), not otherwise specified; amplified probe technique, each organism) had a 2026 Medicare non-facility reimbursement rate of $35.09. This reflects a 0.00% change from the prior year.
The 2026 National Medicare reimbursement for 87798 is $35.09. This item is paid at a standard national rate, so local variation is typically minimal.
Description: Infectious agent detection by nucleic acid (dna or rna), not otherwise specified; amplified probe technique, each organism. Payment policies and coverage rules can still vary by setting and claim details, so confirm final guidance through CMS when needed.
87798 Reimbursement Rate History
| Quarter | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 | Q3 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $35.09 | $35.09 | $35.09 | $35.09 | $35.09 | $35.09 |
Historical Medicare Reimbursement
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q3 | $35.09 | $35.09 | +0.00% | +0.00% |
| 2026 Q2 | $35.09 | $35.09 | +0.00% | +0.00% |
| 2026 Q1 | $35.09 | $35.09 | +0.00% | +0.00% |
| 2025 Q4 | $35.09 | $35.09 | — | — |
| 2025 Q3 | $35.09 | $35.09 | — | — |
| 2025 Q2 | $35.09 | $35.09 | — | — |
| 2025 Q1 | $35.09 | $35.09 | — | — |
Q3 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | ||
| Practice Expense (PE) | ||
| Malpractice (MP) | ||
| Total RVUs | 0.00 | 0.00 |
Are you being paid correctly for this code?
Compare a payment against the Medicare benchmark for this code.
Medicare rates are used as a benchmark only. Actual payer contracts, modifiers, place of service, units, and billing rules may affect reimbursement. This tool is for educational and operational review purposes, not legal or billing advice.
Commercial Payer Rates for 87798
Pro FeatureNational average reimbursement from major commercial payers based on CMS Transparency in Coverage machine-readable files.
| Modifier | Place of Service | Avg. Rate | vs Medicare | Percentile Range |
|---|---|---|---|---|
| NULL | Office (11) | $91.46 | -4.0% | $80 — $104 |
| NULL | Telehealth (02) | $88.20 | -7.4% | $76 — $102 |
| NULL | Facility (21) | $79.31 | -15.6% | $68 — $95 |
| NULL | Outpatient Hospital (22) | $84.92 | -10.2% | $71 — $99 |
| NULL | Home (12) | $96.14 | +1.0% | $84 — $113 |
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Source: CMS Transparency in Coverage machine-readable files (MRFs). Commercial rates reflect payer-published negotiated amounts and may not reflect individual contracted rates.
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Facility vs. Non-Facility (Office) Payment
Facility vs. non-facility pricing most commonly applies to physician services paid under the RVU-based Physician Fee Schedule. For 87798 (Clinical Laboratory Test), the payment methodology may not include both facility and non-facility rates.
Learn How This Reimbursement Is Calculated
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
Frequently Asked Questions
What is the 2026 Medicare rate for 87798?
The 2026 National Average Medicare reimbursement rate for 87798 (Clinical Laboratory Test) is $35.09. This rate is effective as of January 1, 2026.
What is the description for code 87798?
Infectious agent detection by nucleic acid (dna or rna), not otherwise specified; amplified probe technique, each organism
Why do facility and non-facility payments differ for 87798?
Facility vs. non-facility differences usually apply to RVU-based physician services. 87798 may not use both facility and non-facility pricing depending on its payment methodology.
How can I find my local Medicare rate for 87798?
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Is 87798 covered by Medicare?
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.
