CPT code 86160: Complement antigen, each component2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures an individual complement protein antigen, often during evaluation or monitoring of lupus, complement deficiency, and other immune-mediated conditions.
Medicare pays $12.00 for 86160 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
$12.00
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 86160 covers
This laboratory assay measures the antigen concentration of a specified complement protein, commonly in serum. C3 and C4 are examples of individual components measured during evaluation or monitoring of systemic lupus erythematosus and suspected complement deficiencies. Clinical laboratories perform the assay on clinician-submitted specimens; rheumatologists, nephrologists, and primary care clinicians may order it. The result reflects the amount of the measured component, not overall complement function.
Report one unit of 86160 for each distinct complement component measured. Select it for an antigen measurement rather than a functional activity assay or total complement test. Medicare pays 86160 through the CLFS at one national amount across localities, with no geographic or office-versus-facility adjustment. The 2026 national CLFS amount is $12.00, unchanged from 2020 through 2026. The code is excluded from the physician fee schedule.
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 86160
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 86160. 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 86160 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86160 on the lab fee schedule since 2020
86160 · CLFS 2026 Q4 (current)
$12.00
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.
86160 compared with similar tests
- 86161Complement functionPer component tested$12.00
- 86160 measures the antigen amount of an individual complement component. 86161 assesses complement functional activity.
- 86162CH50Total hemolytic activity$20.32
- 86160 measures an individual component's antigen amount; 86162 measures total complement activity using CH50.
- 86140CRP testStandard CRP assay$5.18
- 86160 measures a complement protein antigen. 86140 measures C-reactive protein, a separate marker of inflammation.
86160 billing questions
When should 86160 be selected instead of 86161?
Use 86160 for measuring the antigen amount of an individual complement component. Code 86161 describes a complement functional activity assay.
How many units are reported when multiple components are measured?
Report one unit of 86160 for each distinct complement component measured. Separate C3 and C4 antigen measurements represent two components.
How does 86160 differ from a total complement test?
86160 measures an individual component's antigen amount. Code 86162 is used for total complement activity measured by CH50.
How does Medicare pay for 86160?
Medicare pays 86160 through the CLFS. The code is excluded from the physician fee schedule.
What documentation supports reporting this code?
The laboratory record should identify the complement component measured and show that an antigen measurement was performed. The clinical record should support the reason for testing, such as evaluation or monitoring of an immune-mediated condition.
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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