CPT code 86231: Endomysial antibody, each immunoglobulin class2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Detects endomysial antibodies by immunoglobulin class, commonly used in serologic evaluation when celiac disease is suspected.
Medicare pays $12.09 for 86231 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
$12.09
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2022
- 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 86231 covers
This serologic test detects antibodies directed against endomysium, most often in patients being evaluated for celiac disease. Clinical laboratories typically test serum using indirect immunofluorescence. Endomysial antibody results can support the diagnostic workup alongside other celiac serologies; the immunoglobulin class tested affects how the result is interpreted. A clinician may order the assay during evaluation for suspected celiac disease, and the laboratory reports the result for the immunoglobulin class tested.
Report the test for each immunoglobulin class performed; the code is not a count of specimens. Medicare pays it through the CLFS at one national amount, with no locality or office-versus-facility adjustment. The 2026 national CLFS amount is $12.09, unchanged from 2022 through 2026. The test is paid only through the CLFS.
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 86231
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 86231. 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 86231 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86231 on the lab fee schedule since 2022
86231 · CLFS 2026 Q4 (current)
$12.09
Unchanged since Jan 1, 2022
20 quarterly CLFS releases on file, first CLFS 2022 Q1. A code missing from a quarter wasn’t on that release.
86231 compared with similar tests
- 86258DGP antibodyEach immunoglobulin class$12.05
- This code detects endomysial antibodies; 86258 detects deamidated gliadin peptide antibodies. The targets are distinct, although both may be used in celiac disease evaluation.
- 86364Tissue transglutaminaseEach immunoglobulin class$11.53
- Code 86364 is for tissue transglutaminase antibody testing. Choose based on the antibody assay performed; tTG and endomysial antibodies are separate serologic tests.
- 86255Antibody screenScreening, each antibody$12.05
- Code 86255 describes a fluorescent antibody screen, while 86231 identifies endomysial antibody testing by immunoglobulin class.
- 86256Antibody titerNoninfectious target, each antibody$12.05
- Code 86256 is for a fluorescent antibody titer. Use 86231 when the test performed is specifically endomysial antibody testing by immunoglobulin class.
86231 billing questions
When should this code be reported instead of 86258?
Use 86231 for endomysial antibody testing. Code 86258 represents deamidated gliadin peptide antibody testing, a different antibody target used in celiac serology.
How should the test be counted?
Report by immunoglobulin class tested. The class distinction does not mean one unit for each specimen.
Is a separate physician interpretation billed with this test?
Medicare pays this test through the CLFS; it is not paid under the physician fee schedule.
How does Medicare pay for this laboratory test?
Medicare pays one national CLFS amount per code in every locality, without an office-versus-facility payment difference.
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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