CPT code 86200: Anti-CCP test, rheumatoid arthritis assessment2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures antibodies to cyclic citrullinated peptide to support evaluation of rheumatoid arthritis, including assessment of patients with suspected early inflammatory arthritis.
Medicare pays $12.95 for 86200 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
$12.95
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 86200 covers
This blood test measures antibodies to cyclic citrullinated peptide, commonly called anti-CCP antibodies. Laboratories typically test serum. Rheumatologists and other clinicians order it when evaluating suspected rheumatoid arthritis, including early or undifferentiated inflammatory arthritis. Results are interpreted with the patient’s symptoms, examination, and other laboratory findings; the antibody result alone does not establish the diagnosis.
Report 86200 for the anti-CCP assay performed. It measures a specific antibody and is distinct from rheumatoid factor testing. Medicare pays the test only through the Clinical Laboratory Fee Schedule (CLFS), at one national amount that is the same across states and localities and has no office or facility adjustment. The 2026 national CLFS amount is $12.95, unchanged since 2020. The physician fee schedule excludes this test by statute, so payment is through the CLFS rather than a physician fee schedule service.
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 86200
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 86200. 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 86200 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86200 on the lab fee schedule since 2020
86200 · CLFS 2026 Q4 (current)
$12.95
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.
86200 compared with similar tests
- 86431Rheumatoid factorQuantitative level$5.67
- This code reports quantitative rheumatoid factor testing. Use 86200 for the anti-CCP antibody assay; the tests measure different antibodies and may be ordered together.
- 86430Rheumatoid factorQualitative result$6.14
- This code reports qualitative rheumatoid factor testing, rather than the anti-CCP assay reported with 86200.
- 86225DNA antibodyDouble-stranded DNA$13.74
- This code is for native DNA antibody testing, used in a different autoimmune evaluation. It is not the code for anti-CCP testing.
86200 billing questions
When should 86200 be reported instead of a rheumatoid factor test?
Report 86200 when the laboratory performs an anti-CCP antibody assay. Rheumatoid factor codes represent a different antibody test; they are not substitutes for the assay actually performed.
Can anti-CCP and rheumatoid factor be reported for the same patient?
Yes. They measure different antibodies and may both be ordered during a rheumatoid arthritis evaluation when both assays are performed.
How does Medicare pay for 86200?
Medicare pays 86200 through the CLFS. The code is excluded from the physician fee schedule.
Does payment for 86200 vary by location or setting?
No. The CLFS payment is one national amount across states and localities, with no office or facility adjustment.
What test does 86200 identify?
It identifies measurement of antibodies to cyclic citrullinated peptide, commonly called anti-CCP antibodies.
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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