CPT code 86258: DGP antibody, each immunoglobulin class2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures antibodies to deamidated gliadin peptides, reported by immunoglobulin class during serologic evaluation for celiac disease.
Medicare pays $12.05 for 86258 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 2022
- +4.5%
- 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 86258 covers
This serology test detects antibodies to deamidated gliadin peptides (DGP), an antigen associated with celiac disease. Clinicians may order it as part of a celiac disease evaluation, including when an IgG-based result is useful, such as in a patient with IgA deficiency. The test is generally performed by a clinical laboratory on a blood serum sample; the ordering clinician interprets the result alongside symptoms and other celiac serology.
Report one unit for each immunoglobulin class tested rather than treating different classes as one result. Medicare pays the test from the CLFS at one national amount per code, with no locality or office-versus-facility adjustment. The 2026 national CLFS amount is $12.05, unchanged since 2023. The test is paid only through the CLFS, not under the physician fee schedule.
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 86258
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 86258. 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 86258 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86258 on the lab fee schedule since 2022
86258 · CLFS 2026 Q4 (current)
$12.05
Up 4.5% from $11.53 in 2022
Every change on file
- Jan 1, 2023 · CLFS 2023 Q1$11.53 → $12.05 (+4.5%)
20 quarterly CLFS releases on file, first CLFS 2022 Q1. A code missing from a quarter wasn’t on that release.
86258 compared with similar tests
- 86364Tissue transglutaminaseEach immunoglobulin class$11.53
- This code is for antibodies to deamidated gliadin peptides; 86364 is for tissue transglutaminase antibodies. Select according to the antibody the laboratory tests.
- 86231Endomysial antibodyEach immunoglobulin class$12.09
- This code measures DGP antibodies, while 86231 measures endomysial antibodies. Both may be considered in celiac serology, but they are distinct assays.
- 82784ImmunoglobulinsIgA, IgD, IgG, or IgM$9.30
- 82784 quantifies immunoglobulin levels, such as total IgA; it does not detect antibodies to deamidated gliadin peptides.
86258 billing questions
When is this code used instead of a tissue transglutaminase antibody code?
Use this code when the laboratory measures antibodies to deamidated gliadin peptides. Tissue transglutaminase antibody testing measures a different celiac-associated antibody.
How should different immunoglobulin classes be reported?
Report one unit for each immunoglobulin class tested. Do not combine testing for different classes as a single unit.
What specimen is generally used?
DGP antibody testing is generally performed on a blood serum sample.
Is a physician interpretation billed separately?
Medicare pays this test only through the CLFS. The physician fee schedule does not provide separate payment for the test.
Does Medicare use a local or facility-specific CLFS amount?
No. Medicare uses one national CLFS amount for the code across localities, without an office-versus-facility adjustment.
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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