CPT code 86037: ANCA titer, each antibody2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures the titer of an antineutrophil cytoplasmic antibody, typically as follow-up to screening during evaluation of suspected ANCA-associated vasculitis.
Medicare pays $12.05 for 86037 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 86037 covers
This test determines the titer of an antineutrophil cytoplasmic antibody (ANCA), often after an ANCA screen is positive. Clinicians may order it when evaluating suspected ANCA-associated vasculitis, including granulomatosis with polyangiitis or microscopic polyangiitis. Testing is generally performed by a clinical laboratory on serum; indirect immunofluorescence is a common method for identifying ANCA patterns and titers. The result helps characterize the antibody finding alongside the patient’s clinical presentation and other laboratory results.
Report this service for each antibody titered, rather than for screening alone. The laboratory record should identify the antibody tested and its titer. Medicare pays code 86037 through the CLFS only; the 2026 national amount is $12.05, unchanged from 2022 through 2025. The amount is the same in every state and locality, with no geographic or office-versus-facility adjustment. The physician fee schedule excludes this test by statute.
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 86037
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 86037. 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 86037 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86037 on the lab fee schedule since 2022
86037 · 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.
86037 compared with similar tests
- 86036ANCA screenEach antibody$12.05
- Use 86036 for ANCA antibody screening. Use 86037 when the laboratory determines a titer for an antibody.
- 86038ANA testScreening$12.09
- 86038 tests for antinuclear antibodies (ANA), not antineutrophil cytoplasmic antibodies. The tests assess different autoantibodies.
- 86039ANATiter measurement$11.16
- 86039 reports an ANA titer by pattern; 86037 reports an ANCA titer for each antibody.
86037 billing questions
When should 86037 be reported instead of 86036?
Report 86036 for screening ANCA antibodies. Report 86037 when the laboratory determines a titer for an antibody.
Is 86037 reported once for all ANCA antibodies?
The code describes titration of each antibody. The laboratory documentation should identify which antibody or antibodies were titrated.
What should the laboratory report document?
Document the antibody tested and its titer.
Does Medicare pay 86037 under the physician fee schedule?
No. Medicare pays this test through the CLFS only, at one national amount that applies across localities and settings.
Can 86037 be reported with an ANA test?
ANCA and ANA testing assess different autoantibodies and may be ordered together during an autoimmune evaluation. Report each test only when the corresponding laboratory service was performed.
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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