2024 Laboratory Fee Schedule

Fee schedules do not reflect 2% Payment Adjustment (Sequestration).
Click here for more information.


Please select your state/locality before continuing:



Respiratory Health Test
Visby Medical Respiratory Health Test-Emergency Use Authorization
CPT Code
CPT Code Description
Medicare Coverage
CALIFORNIA
Medicare
Reimbursement
CALIFORNIA
Medicaid
Reimbursement
87636-QW*
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique
  CCI   MUE   A57526 A58720
$142.63
$142.63

*QW should only be used when running this test in a CLIA Waived setting.


STI CT/NG/TV (If all tests are ordered and performed)
CPT Code
CPT Code Description
Medicare Coverage
CALIFORNIA
Medicare
Reimbursement
CALIFORNIA
Medicaid
Reimbursement
87801-QW*
Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique
  CCI   MUE   A55326 A57526 A58720
$ 70.20
$38.80

*QW should only be used when running this test in a CLIA Waived setting.




STI CT/NG/TV (If a single test is ordered and performed)
CPT Code
CPT Code Description
Medicare Coverage
CALIFORNIA
Medicare
Reimbursement
CALIFORNIA
Medicaid
Reimbursement
87491
Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique
  CCI   MUE   NCD
$ 35.09
$31.17
87591
Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique
  CCI   MUE   NCD
$ 35.09
$31.07
87661
Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique
  CCI   MUE   A58720
$ 35.09
$30.54


Medicaid Reimbursement information source: California Medicaid Fee Schedule available at:
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/rates.
Medi-Cal Rates as of 2/15/2024
Last updated by CodeMap on 02/18/2024.

Medicaid coverage and payment amounts are subject to many factors exclusively controlled by each State Medicaid Program. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicaid information is error-free or that the use of this information will result in coverage and subsequent payment of claims.

The information contained in this website has been compiled by CodeMap, L.L.C. who remains solely responsible for its content. The information provided is for general educational purposes only and may not be conclusive or exhaustive. Recent changes in applicable law, regulations and interpretations may not be reflected in the information contained herein. For technical questions, please contact CodeMap at (847) 381-5465.

This website is a private website and is not associated, endorsed or authorized by the Department of Health and Human Services, the Center for Medicare and Medicaid Services or any other public or government organization or agency.

CPT copyright 2023 American Medical Association. All rights reserved.