CPT code 83516: Immunoassay, multiple-step, qualitative or semiquantitative2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reports a multiple-step immunoassay that qualitatively or semiquantitatively measures an analyte other than an infectious agent antigen or antibody.
Medicare pays $11.53 for 83516 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
$11.53
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
- QW · CLIA-waived test
- $11.53
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 83516 covers
Clinical laboratories report 83516 for a qualitative or semiquantitative analysis using a multiple-step immunoassay when the target is neither an infectious-agent antibody nor an infectious-agent antigen. The code is distinguished by the assay method and result type: it is distinct from dipstick immunoassay reporting, radioimmunoassay, and quantitative immunoassay reporting. This test produces a qualitative or semiquantitative result rather than a quantitative one.
Medicare pays 83516 only through the CLFS. The 2026 national amount is $11.53, unchanged since 2020; one amount applies across all states and localities, without an office or facility difference. For the CLIA-waived version, sites holding a CLIA certificate of waiver may perform the test and report modifier QW. The Medicare physician fee schedule excludes the test.
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 83516
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 83516. 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 83516 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 83516 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $11.53.
83516 on the lab fee schedule since 2020
83516 · CLFS 2026 Q4 (current)
$11.53
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.
83516 compared with similar tests
- 83518ImmunoassaySingle-step, noninfectious analyte$9.64
- 83518 identifies a dipstick immunoassay. Choose 83516 for the multiple-step method when the result is qualitative or semiquantitative.
- 83519RadioimmunoassayQuantitative measurement$18.40
- 83519 is for radioimmunoassay methodology. Choose 83516 for a qualifying multiple-step immunoassay with a qualitative or semiquantitative result.
- 83520Quantitative immunoassayNot otherwise specified$17.27
- 83520 describes a quantitative immunoassay. Choose 83516 when the assay result is qualitative or semiquantitative.
83516 billing questions
When should this code be used instead of 83520?
Use 83516 for a qualifying multiple-step immunoassay with a qualitative or semiquantitative result. Code 83520 describes a quantitative immunoassay.
How does 83516 differ from 83518?
Code 83518 is for a dipstick immunoassay. Use 83516 for a qualifying multiple-step immunoassay rather than the dipstick method.
When is modifier QW reported?
Report QW for the CLIA-waived version when it is performed by a site holding a CLIA certificate of waiver.
Does 83516 cover infectious-agent antigen or antibody testing?
No. This code describes immunoassay analysis of a substance other than an infectious-agent antigen or antibody.
How does 83516 differ from 83519?
Code 83519 is for radioimmunoassay methodology. Code 83516 describes a multiple-step immunoassay with a qualitative or semiquantitative result.
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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