CPT code 86015: Actin antibody, smooth muscle antibody2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures serum antibodies to actin, also called smooth muscle antibodies, as part of evaluation for suspected autoimmune hepatitis and related liver disease.
Medicare pays $12.05 for 86015 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
$12.05
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2022
- +4.5%
- 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 86015 covers
This test measures antibodies directed against actin, also known as smooth muscle antibodies. It is commonly ordered by gastroenterologists, hepatologists, and other clinicians evaluating suspected autoimmune hepatitis, particularly type 1 autoimmune hepatitis. Testing is generally performed by a clinical laboratory on serum. The result contributes to the clinical assessment alongside symptoms, liver enzyme findings, and other serologic tests; it does not establish a diagnosis by itself.
Report 86015 for the actin antibody measurement, rather than for a different autoantibody or an antinuclear antibody titer. Medicare pays the test under the CLFS, with one national amount applying across states and localities and no office-versus-facility difference. The 2026 national CLFS amount is $12.05, unchanged since 2023. The test is excluded from the physician fee schedule and is paid only through the CLFS.
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 86015
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 86015. 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 86015 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86015 on the lab fee schedule since 2022
86015 · CLFS 2026 Q4 (current)
$12.05
Up 4.5% from $11.53 in 2022
Every change on file
- Jan 1, 2023 · CLFS 2023 Q1$11.53 → $12.05 (+4.5%)
20 quarterly CLFS releases on file, first CLFS 2022 Q1. A code missing from a quarter wasn’t on that release.
86015 compared with similar tests
- 86038ANA testScreening$12.09
- 86038 measures antinuclear antibodies. Choose 86015 when the requested test is specifically for actin or smooth muscle antibodies.
- 86039ANATiter measurement$11.16
- 86039 reports an ANA titer, not an actin antibody measurement. The antibody target determines which code applies.
- 86036ANCA screenEach antibody$12.05
- 86036 is for ANCA screening, a different autoantibody evaluation. It does not represent smooth muscle or actin antibody testing.
86015 billing questions
When should 86015 be used instead of an ANA test?
Use 86015 when the test measures antibodies to actin or smooth muscle, commonly during evaluation for autoimmune hepatitis. ANA testing measures a different autoantibody target.
Is 86015 the same as an ANCA test?
No. 86015 measures actin antibodies; ANCA testing evaluates antibodies associated with a different set of autoimmune conditions.
How many units are reported?
The code represents the actin antibody measurement on an each basis. Do not use it to report a different antibody specificity or an ANA titer.
Does Medicare pay 86015 under the physician fee schedule?
No. Medicare pays this laboratory test through the CLFS, with one national amount across localities and no office-versus-facility 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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