CPT code 86235: ENA antibody, each antibody2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures an antibody to a specific extractable nuclear antigen to help assess autoimmune disorders, with each antibody reported separately.
Medicare pays $17.93 for 86235 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
$17.93
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 86235 covers
This assay measures antibodies directed against extractable nuclear antigens by any method. The targets include RNP, SS-A, SS-B, Smith, Scl-70, and Jo-1. Clinicians use the results to assess autoimmune disorders. Each result identifies a distinct antibody specificity, so the code is reported for each antibody tested. Antigen specificity distinguishes these results from native-DNA antibody testing.
Report one service for each distinct antibody tested, rather than one service for a multi-antibody panel. Medicare pays this laboratory test through the CLFS, not the physician fee schedule. The 2026 national CLFS amount is $17.93, unchanged from 2020 through 2026. The same amount applies in every state and locality, with no office or facility payment difference.
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 86235
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 86235. 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 86235 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86235 on the lab fee schedule since 2020
86235 · CLFS 2026 Q4 (current)
$17.93
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.
86235 compared with similar tests
- 86225DNA antibodyDouble-stranded DNA$13.74
- Use 86225 for antibody to native DNA. Use 86235 for an antibody to an extractable nuclear antigen, such as Sm or RNP.
- 86226DNA antibodySingle-stranded$12.11
- Code 86226 identifies single-stranded DNA antibody testing; 86235 identifies extractable nuclear antigen antibody testing.
86235 billing questions
Does one unit represent an ENA panel or one antibody?
Report each distinct antibody tested separately. A panel that tests several antibody specificities does not make them one antibody measurement.
How is this different from a native DNA antibody test?
This code is for an antibody to an extractable nuclear antigen, such as Sm or SS-A. Code 86225 is for native DNA antibody testing.
Can this be reported with a native DNA antibody test?
Yes, if both tests are performed. They measure different antibody targets and may be ordered during the same autoimmune evaluation.
How does Medicare pay for this test?
Medicare pays this laboratory test through the CLFS; it is excluded from the physician fee schedule.
Is there a separate physician interpretation payment?
The test is paid through the CLFS only; this code has no separate physician interpretation payment.
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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