CPT code 86225: DNA antibody, double-stranded DNA2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures antibodies to native double-stranded DNA, commonly ordered during evaluation or follow-up of systemic lupus erythematosus.
Medicare pays $13.74 for 86225 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
$13.74
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 86225 covers
This assay measures antibodies directed against native, double-stranded DNA. Clinicians commonly order it when evaluating suspected systemic lupus erythematosus or monitoring a patient with established disease. A clinical laboratory generally performs the test on serum from a blood specimen. Results are interpreted with clinical findings and other autoimmune serology. This assay is distinct from testing for single-stranded DNA antibodies and from assays targeting specific nuclear antigens.
Report 86225 for the native or double-stranded DNA antibody assay performed. Medicare pays the test through the Clinical Laboratory Fee Schedule (CLFS), with one amount per code. The 2026 national CLFS amount is $13.74, unchanged since 2020. The same CLFS amount applies nationwide, without locality or office-versus-facility adjustment.
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 86225
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 86225. 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 86225 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86225 on the lab fee schedule since 2020
86225 · CLFS 2026 Q4 (current)
$13.74
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.
86225 compared with similar tests
- 86226DNA antibodySingle-stranded$12.11
- Choose 86225 for native double-stranded DNA antibodies and 86226 for single-stranded DNA antibodies.
- 86235ENA antibodyEach antibody$17.93
- Code 86235 is for nuclear antigen antibody testing; 86225 specifically measures antibodies to native double-stranded DNA.
- 86038ANA testScreening$12.09
- Code 86038 is an antinuclear antibody screen, whereas 86225 measures antibodies directed against native double-stranded DNA.
86225 billing questions
When should 86225 be chosen instead of 86226?
Use 86225 for antibodies to native, double-stranded DNA. Code 86226 identifies antibodies to single-stranded DNA.
Is 86225 the same test as an ANA screen?
No. Code 86225 measures antibodies to native double-stranded DNA, while 86038 is used for an antinuclear antibody screen.
Can 86225 be reported with an ANA test?
Yes. The tests measure different antibody findings and may be ordered in the same autoimmune evaluation when clinically appropriate.
What documentation supports reporting 86225?
The laboratory record should identify the native or double-stranded DNA antibody assay performed, and the medical record should support the clinical evaluation or follow-up for which it was ordered.
How does Medicare pay for 86225?
Medicare pays it under the CLFS at one national amount per code. Payment is the same across localities and in office and facility settings.
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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