CPT code 86036: ANCA screen, each antibody2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Screens for antineutrophil cytoplasmic antibodies during evaluation of suspected ANCA-associated vasculitis or related inflammatory disease.
Medicare pays $12.05 for 86036 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
- 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 86036 covers
This laboratory screen looks for antineutrophil cytoplasmic antibodies (ANCA), which may be found in some forms of small-vessel vasculitis. Clinicians may order it when evaluating findings such as unexplained kidney inflammation, pulmonary bleeding, or other signs that raise concern for vasculitis. The test is performed by a clinical laboratory on a patient specimen, commonly serum.
Report 86036 for each antibody screened. A subsequent antibody titer is a distinct service reported with 86037 when performed. Medicare pays 86036 only through the CLFS; the 2026 national CLFS amount is $12.05. The same national amount applies across states and localities, with no geographic or office-versus-facility adjustment. The code is excluded from the physician fee schedule, so payment is through the CLFS rather than a separate physician interpretation component.
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 86036
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 86036. 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 86036 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86036 on the lab fee schedule since 2022
86036 · CLFS 2026 Q4 (current)
$12.05
Unchanged since Jan 1, 2022
20 quarterly CLFS releases on file, first CLFS 2022 Q1. A code missing from a quarter wasn’t on that release.
86036 compared with similar tests
- 86037ANCA titerEach antibody$12.05
- 86036 reports ANCA screening for each antibody; 86037 reports the titer for each antibody.
- 86038ANA testScreening$12.09
- 86038 is for antinuclear antibody testing, not antineutrophil cytoplasmic antibody screening.
- 86039ANATiter measurement$11.16
- 86039 reports an ANA titer. It is distinct from the ANCA screen reported with 86036.
86036 billing questions
When should 86036 be used instead of 86037?
Use 86036 for the ANCA screen for each antibody. Code 86037 reports an antibody titer, a distinct measurement that may follow screening.
How is the each-antibody language reflected in reporting?
Report the screen for each antibody tested. Do not treat the code as a single panel covering an unspecified number of antibodies.
Is modifier 26 appropriate for 86036?
No. Medicare pays 86036 through the CLFS, and the code represents the laboratory test rather than a separately reported physician interpretation.
Which fee schedule applies to 86036?
Medicare pays 86036 through the CLFS. The national amount applies across localities, without an office-versus-facility payment difference.
How does 86036 differ from an ANA test?
86036 screens for antineutrophil cytoplasmic antibodies. ANA screening and ANA titers are reported with 86038 and 86039, respectively, and address a different antibody target.
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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