CPT code 0580U: Lyme IgG test, 31 recombinant protein groups2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This immunoassay detects IgG antibodies to Borrelia burgdorferi and is reported during laboratory evaluation for suspected Lyme disease.
Medicare pays $17.21 for 0580U 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
$17.21
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2026
- 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 0580U covers
This proprietary laboratory analysis detects IgG antibodies to Borrelia burgdorferi, the bacterium associated with Lyme disease. It uses an immunoassay to assess antibody reactivity across 31 recombinant protein groups; it measures an antibody response rather than detecting the organism directly. A clinical laboratory reports the assay when ordered as part of laboratory evaluation for suspected Lyme disease.
Report 0580U for this specific IgG immunoassay. Select the code according to the test performed: this assay is distinct from Lyme antibody testing represented by 86618 and confirmatory Borrelia burgdorferi antibody testing represented by 86617. Medicare pays 0580U through the Clinical Laboratory Fee Schedule (CLFS). The 2026 national CLFS amount is $17.21; one amount applies in every state and locality, with no geographic or office/facility payment adjustment. The code is paid through the CLFS only.
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 0580U
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 0580U. 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.
Not on the physician fee schedule
The physician fee schedule doesn’t list 0580U: Medicare pays the test only from the CLFS.
0580U on the lab fee schedule since 2025
0580U · CLFS 2026 Q4 (current)
$17.21
Unchanged since Jan 1, 2026
Every change on file
- Jan 1, 2026 · CLFS 2026 Q1MAC-priced → $17.21
5 quarterly CLFS releases on file, first CLFS 2025 Q4. A code missing from a quarter wasn’t on that release.
0580U compared with similar tests
- 86618Lyme antibodyLyme disease antibody$17.03
- Use 0580U for the specified IgG immunoassay evaluating 31 recombinant protein groups. Use 86618 when the performed service is the Lyme disease antibody test represented by that code.
- 86617Lyme antibodyConfirmatory assay$15.49
- 86617 represents confirmatory Borrelia burgdorferi antibody testing, such as an immunoblot. 0580U identifies a distinct IgG immunoassay evaluating recombinant protein groups.
0580U billing questions
How does 0580U differ from 86618?
0580U identifies an IgG immunoassay evaluating 31 recombinant protein groups. Use 86618 when the Lyme disease antibody service represented by that code is the test performed.
Does 0580U detect the Lyme organism directly?
No. It detects IgG antibodies to Borrelia burgdorferi, rather than the organism itself.
What do the 31 recombinant protein groups describe?
They describe the groups evaluated by this IgG antibody immunoassay.
When would 86617 be considered instead?
86617 represents confirmatory Borrelia burgdorferi antibody testing, such as an immunoblot. Select the code that describes the laboratory method performed.
How does Medicare pay 0580U?
Medicare pays the code through the CLFS at one national amount across localities, without an office or facility payment difference.
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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