CPT code 86226: DNA antibody, single-stranded2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures antibodies that bind single-stranded DNA and is reported when this specific autoantibody assay is performed in an autoimmune serology evaluation.
Medicare pays $12.11 for 86226 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
$12.11
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 86226 covers
86226 identifies the laboratory measurement of antibodies that bind single-stranded DNA. It is distinct from testing for native double-stranded DNA and from assays directed at other nuclear antigens. Clinicians may order the assay in autoimmune serology evaluations, including assessment of suspected lupus or connective tissue disease. Anti-single-stranded DNA reactivity is not specific to one diagnosis, so results are considered with clinical findings and other serologic results. A clinical laboratory performs and reports the antibody measurement.
Report 86226 when the assay measures antibodies to single-stranded DNA, rather than native DNA or a broader fluorescent antibody screen. Medicare pays 86226 only through the CLFS, at one national amount without geographic or office-versus-facility adjustment. The 2026 national CLFS amount is $12.11, unchanged since 2020. The test is excluded from the physician fee schedule by statute.
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 86226
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 86226. 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 86226 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86226 on the lab fee schedule since 2020
86226 · CLFS 2026 Q4 (current)
$12.11
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.
86226 compared with similar tests
- 86225DNA antibodyDouble-stranded DNA$13.74
- Choose 86226 for single-stranded DNA antibody testing and 86225 for native DNA antibody testing.
- 86235ENA antibodyEach antibody$17.93
- 86235 is for nuclear antigen antibody testing; 86226 identifies antibodies directed specifically against single-stranded DNA.
- 86255Antibody screenScreening, each antibody$12.05
- 86255 reports a fluorescent antibody screen, while 86226 reports testing for a specific DNA antibody target.
86226 billing questions
How does 86226 differ from 86225?
86226 identifies testing for antibodies to single-stranded DNA. Use 86225 when the assay measures antibodies to native DNA.
Is 86226 a general ANA screen?
No. It identifies a specific single-stranded DNA antibody assay, unlike a broader fluorescent antibody screen such as 86255.
What should the record identify?
The documentation should identify the single-stranded DNA antibody assay performed and distinguish it from testing for native DNA or a broader antibody screen.
Does Medicare pay 86226 under the physician fee schedule?
No. Medicare pays the test through the CLFS, with one national amount across localities and no office-versus-facility adjustment.
Should 86226 be reported for native DNA antibody testing?
No. Report 86225 for testing directed at native DNA; 86226 is for single-stranded DNA antibody measurement.
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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