CPT code 86256: Antibody titer, noninfectious target, each antibody2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures by fluorescence the titer of an antibody to a noninfectious agent, reported separately for each antibody tested.
Medicare pays $12.05 for 86256 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 86256 covers
Code 86256 reports fluorescent measurement of an antibody titer directed against a noninfectious agent, with each antibody represented separately. Clinical laboratories perform and report the test. It distinguishes a titer result from a fluorescent antibody screen and from testing identified by a specific antibody target, such as native DNA or nuclear antigen.
Report the code for each antibody titer performed. Medicare pays the laboratory test under the CLFS at one national amount; the 2026 national amount is $12.05, unchanged since 2020. The same amount applies across states and localities, with no geographic or office-versus-facility adjustment. A separately provided physician interpretation is payable under the physician fee schedule with modifier 26.
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 86256
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 86256. 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 86256 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.
86256 on the lab fee schedule since 2020
86256 · 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.
86256 compared with similar tests
- 86255Antibody screenScreening, each antibody$12.05
- 86255 identifies a fluorescent antibody screen; 86256 identifies a fluorescent antibody titer.
- 86225DNA antibodyDouble-stranded DNA$13.74
- 86225 identifies native DNA antibody testing. Code 86256 identifies a fluorescent titer for an antibody to a noninfectious agent.
- 86235ENA antibodyEach antibody$17.93
- 86235 identifies nuclear antigen antibody testing. Code 86256 identifies a fluorescent titer for an antibody to a noninfectious agent.
86256 billing questions
How does 86256 differ from 86255?
86255 identifies a fluorescent antibody screen, while 86256 identifies a fluorescent antibody titer.
How many units should be reported?
Report the code for each antibody titer performed.
Can the physician interpretation be billed separately?
A separately provided physician interpretation is payable under the physician fee schedule with modifier 26. The laboratory test itself is paid under the CLFS.
Is the test paid differently in an office and a facility?
No. Medicare pays one national CLFS amount for the code, with no locality or office-versus-facility adjustment.
How does 86256 differ from native DNA antibody testing?
86225 identifies native DNA antibody testing; 86256 identifies a fluorescent titer for an antibody to a noninfectious agent. Report the code that matches the test 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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