CPT code 86038: ANA test, screening2026 Medicare lab fee · Clinical Laboratory Fee Schedule
An antinuclear antibody screening test helps evaluate suspected systemic autoimmune disease, including lupus, and is reported for the screening assay performed.
Medicare pays $12.09 for 86038 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
$12.09
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
- 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 86038 covers
This blood test looks for antinuclear antibodies, which can support evaluation for systemic autoimmune disorders such as systemic lupus erythematosus. Clinicians may order it when symptoms or findings suggest an autoimmune connective-tissue disease. Hospital and independent laboratories perform the assay on a provider’s order, and the result is interpreted alongside the patient’s clinical findings; a positive result alone does not establish a specific diagnosis.
Report 86038 for the ANA screening assay, rather than for a subsequent titer. When a titer is performed, 86039 identifies that distinct service; whether it is performed or reported depends on the testing and order. Medicare pays 86038 only through the CLFS, with one national amount and no locality or office-versus-facility adjustment. The 2026 national CLFS amount is $12.09, unchanged from 2020 through 2026. The code has no separate physician-fee-schedule payment.
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 86038
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 86038. 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 86038 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86038 on the lab fee schedule since 2020
86038 · CLFS 2026 Q4 (current)
$12.09
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.
86038 compared with similar tests
- 86039ANATiter measurement$11.16
- 86038 identifies the ANA screening assay; 86039 identifies an ANA titer. The titer is reported when that distinct testing is performed.
- 86225DNA antibodyDouble-stranded DNA$13.74
- 86225 is a specific anti-double-stranded DNA antibody test, not a general ANA screen. It may be ordered as a separate test during autoimmune evaluation.
- 86235ENA antibodyEach antibody$17.93
- 86235 covers testing for extractable nuclear antigen antibodies. It is a more specific antibody service than the general ANA screening assay reported with 86038.
86038 billing questions
When should 86038 be reported instead of 86039?
Use 86038 for the ANA screening assay. Use 86039 when an ANA titer is performed; a titer is a distinct service, not another unit of the screen.
Does a positive ANA screen automatically include a separately reportable titer?
A positive result does not by itself establish that a titer was performed. Report 86039 only when the titer service was actually performed and documented.
Is 86038 billed per antibody or per specimen?
Report the screening assay performed under 86038, not a separate unit for each antibody detected. Do not use multiple units merely because the result identifies ANA reactivity.
How does Medicare pay for 86038?
Medicare pays the test through the CLFS at one national amount, without locality or office-versus-facility adjustment. It has no separate physician-fee-schedule payment.
Can 86038 be reported with disease-specific autoantibody tests?
Yes, when those distinct tests are also ordered and performed. For example, anti-double-stranded DNA or extractable nuclear antigen testing may be part of the same autoimmune evaluation.
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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