What is the 2026 reimbursement for CPT 87591?

CPT 87591 is reimbursed via the Clinical Laboratory Fee Schedule (CLFS). The payment is a flat fee determined by the national CLFS rate, not by RVUs.

Does the patient have to pay for a gonorrhea screen?

For Medicare and most ACA-compliant plans, gonorrhea screening (87591) for high-risk or pregnant patients is a preventive service with $0 cost-sharing when billed with the appropriate screening ICD-10 code (e.g., Z11.3).

What is the 'amplified probe technique' in 87591?

It refers to Nucleic Acid Amplification Testing (NAAT), such as PCR or TMA. This is more sensitive than direct probe tests (87590) and is the clinical standard for STI diagnosis.

Can I bill 87591 with Chlamydia testing (87491)?

Yes. These are often performed together from the same specimen. You should bill both codes separately unless your payer requires a specific panel code.

LabsBase2026 Compliant

CPT 87591

2026 Billing Guide

N. gonorrhoeae DNA Amp Probe

Reimbursement

$25.36

Threshold

N/A

2026 Status

Active

What is CPT Code 87591?

CPT 87591 is defined as: A molecular diagnostic test for the detection of Neisseria gonorrhoeae (the causative agent of gonorrhea) using an amplified nucleic acid probe technique (e.g., PCR, TMA). This methodology is highly sensitive and specific, allowing for the detection of the pathogen from various specimen types, including urine, endocervical swabs, and urethral swabs. It is the preferred method for screening and diagnosis of gonorrhea infections.

This code is primarily used for Labs services. It falls under the category of Pathology and Laboratory / Microbiology and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.

2026 RVU Components

Relative Value Units (Non-Facility)

Standard Formula Applied

Work RVU

Physician Effort

PE (Non-Fac)

Practice Expense

Malpractice

Risk Factor

Total RVU

Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor

2026 CMS Policy Intelligence

clfs pricing

87591 is reimbursed under the Clinical Laboratory Fee Schedule (CLFS). In 2026, CMS continues to adjust CLFS rates based on private payer data reporting (PAMA).

preventive status

For many payers (including Medicare for high-risk individuals), gonorrhea screening is a covered preventive service with $0 patient cost-sharing.

conversion factor

The $33.40 conversion factor applies to the professional component of any related interpretation, though 87591 itself is typically a technical flat fee.

Administrative Framework

Place of Service

81 (Independent Lab)11 (Office)22 (Outpatient Hospital)

NCCI Exclusions

Do not bill with:87590875928785087491 (often billed together as a panel)

Key Modifiers

59Distinct procedural service. Used if separate tests for different infectious agents are billed but not part of a combined bundle.

90Reference (Outside) Laboratory. Used if the drawing office bills the payer but sends the specimen to a reference lab.

Operational Requirements

methodology verification

Ensure the lab is using an 'amplified' probe technique (87591) rather than a direct probe (87590). Amplified techniques generally have higher reimbursement.

clia compliance

The performing laboratory must have a CLIA certificate of compliance or accreditation for moderate or high-complexity testing (unless the test is QW waived).

panel billing

If Neisseria gonorrhoeae is tested alongside Chlamydia trachomatis, ensure they are billed as separate line items or as a combined panel code if required by the payer.

medical necessity linkage

The test must be ordered by a physician based on symptoms or for a screening purpose covered by the patient's plan.

Compliance Checklist

Detailed time tracking (cumulative for the month).

Specific clinical decision-making documentation.

Electronic care plan availability and access log.

Audit Defense

No specific audit defense elements defined.

2026 Update

Paid under CLFS flat fee. Use Z11.3 for screening to trigger zero cost-sharing where applicable.

Common Clinical Scenarios

No clinical examples provided.

Target Specialties & Utilization

Primary CareOB/GYNInfectious DiseaseUrology

Typical Clinical Indications (ICD-10)

A54.00 (Gonococcal infection of lower genitourinary tract, unspecified)Z11.3 (Encounter for screening for infections with a predominantly sexual mode of transmission)N76.0 (Acute vaginitis)

Frequently Asked Questions

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Official Data Provider: CMS Physician Fee Schedule (2026)