CPT code 86255: Antibody screen, screening, each antibody2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Screens for an antibody to a noninfectious target using fluorescence; report the service for each antibody screened.
Medicare pays $12.05 for 86255 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
$12.05
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 86255 covers
CPT 86255 represents fluorescent screening for an antibody directed against a noninfectious agent. The code is reported for each antibody screened and describes a screening service rather than a titer measurement. A titer is a distinct service reported under 86256, not the screening service coded here.
Medicare pays the laboratory test under the CLFS at one national amount in every state and locality, without an office-versus-facility payment difference. The 2026 national CLFS amount is $12.05, unchanged from 2020 through 2026. A separate physician interpretation is payable under the physician fee schedule when billed with modifier 26; this is distinct from the CLFS-paid laboratory test.
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 86255
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 86255. 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 86255 with status X (excluded by statute), so the test itself is paid only from the CLFS.
Physician interpretation (modifier 26)
A physician’s interpretation is billed separately with modifier 26 and paid under the physician fee schedule: $17.70 nationally in the office, before locality adjustment.
86255 on the lab fee schedule since 2020
86255 · CLFS 2026 Q4 (current)
$12.05
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.
86255 compared with similar tests
- 86256Antibody titerNoninfectious target, each antibody$12.05
- 86255 reports fluorescent antibody screening; 86256 reports a fluorescent antibody titer.
- 86038ANA testScreening$12.09
- Use 86038 for an antinuclear antibody screen. Use 86255 for fluorescent screening for an antibody to a noninfectious target when that is the service performed.
- 86225DNA antibodyDouble-stranded DNA$13.74
- Use 86225 when testing for native DNA antibody. Code 86255 describes fluorescent screening for an antibody to a noninfectious target.
86255 billing questions
When should 86255 be reported instead of 86256?
Use 86255 for a fluorescent antibody screen. Use 86256 when the service measures an antibody titer.
How many units should be reported?
Report one service for each antibody screened. The order and laboratory report should support the antibody or antibodies tested.
Can a physician interpretation be billed separately?
A separate physician interpretation is payable under the physician fee schedule when billed with modifier 26.
How does Medicare pay for the laboratory test?
The test is paid under the CLFS at one national amount that applies in every state and locality, with no office or facility payment difference.
Is 86255 the right code for every antibody screen?
No. It describes fluorescent screening for an antibody to a noninfectious target. Use a code that describes the specific antibody test when that is the service performed.
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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