CPT code 86162: CH50, total hemolytic activity2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures total hemolytic complement activity, commonly to assess suspected complement deficiency or complement pathway abnormalities in patients with recurrent infections.
Medicare pays $20.32 for 86162 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
$20.32
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 86162 covers
The CH50 assay measures the ability of serum complement proteins to produce hemolysis through the classical pathway. Clinicians may order it when evaluating suspected complement deficiency, recurrent infections such as Neisseria infections, or complement abnormalities associated with immune-mediated disease. Clinical laboratories perform and report the test; the result reflects functional activity rather than the concentration of an individual complement protein.
Report 86162 for the total hemolytic complement assay performed. It is often considered alongside complement component measurements or another complement functional assay, depending on the clinical question. Medicare pays the test only through the CLFS. The 2026 national CLFS amount is $20.32, unchanged since 2020; the same amount applies in every locality, with no office or facility difference. 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 86162
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 86162. 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 86162 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86162 on the lab fee schedule since 2020
86162 · CLFS 2026 Q4 (current)
$20.32
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.
86162 compared with similar tests
- 86160Complement antigenEach component$12.00
- 86160 measures complement antigen, such as an individual component; 86162 measures total hemolytic function.
- 86161Complement functionPer component tested$12.00
- 86161 describes a complement functional assay other than CH50, while 86162 is the total hemolytic CH50 assay.
- 86140CRP testStandard CRP assay$5.18
- 86140 measures C-reactive protein as an inflammatory marker. It does not measure complement function.
86162 billing questions
When should 86162 be used instead of 86160?
Use 86162 for the functional CH50 hemolysis test. Code 86160 describes measurement of complement antigen, such as an individual complement component.
How does CH50 differ from 86161?
CH50 measures total hemolytic activity through the classical pathway. Code 86161 describes a complement functional assay other than CH50; the tests may be selected together when the evaluation calls for more than one functional assessment.
How many units should be reported?
Report one service for the CH50 assay performed; do not count individual complement proteins as units of 86162.
Is 86162 paid under the physician fee schedule?
No. Medicare pays 86162 only through the CLFS, using one national amount across localities and settings.
Can 86162 be reported with a complement antigen test?
Yes, when both the functional CH50 assay and a complement antigen measurement are performed and documented. The tests measure different aspects of complement.
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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