CPT code 86301: CA 19-9, quantitative tumor antigen2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Quantitative CA 19-9 immunoassay measures a tumor-associated antigen, most often to help monitor pancreatic or biliary cancer treatment alongside clinical assessment.
Medicare pays $20.81 for 86301 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
$20.81
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 86301 covers
86301 identifies quantitative immunoassay for CA 19-9, a tumor-associated antigen measured in blood, typically serum. Clinicians most often order it for patients with pancreatic cancer and may use serial results to assess treatment response alongside symptoms, imaging, and other findings. It is also used in the evaluation and management of biliary tract and other gastrointestinal cancers; an elevated result alone does not diagnose cancer. Hospital and independent laboratories perform and report the test for oncology, gastroenterology, and other treating clinicians.
Report 86301 for the quantitative CA 19-9 assay. Select marker-specific codes for CA 15-3 or CA 125, and use 86316 for another tumor antigen covered by that code. Medicare pays 86301 under the CLFS at one national amount per code in every state and locality, with no geographic adjustment or office-versus-facility difference. The 2026 national CLFS amount is $20.81, unchanged each year from 2020 through 2025. The test is paid only under the CLFS, not 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 86301
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 86301. 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 86301 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86301 on the lab fee schedule since 2020
86301 · CLFS 2026 Q4 (current)
$20.81
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.
86301 compared with similar tests
- 86300Tumor markerCA 15-3 quantitative assay$20.81
- 86300 identifies CA 15-3; 86301 identifies CA 19-9. Select the code for the specific antigen measured.
- 86304CA 125Quantitative tumor antigen$20.81
- 86304 is for CA 125, while 86301 is specific to CA 19-9.
- 86316Tumor markerQuantitative, each antigen$20.81
- 86316 is for another tumor antigen not identified by a specific code such as 86301.
86301 billing questions
When should 86301 be selected instead of another tumor-marker code?
Use 86301 when the assay measures CA 19-9. CA 15-3 and CA 125 have their own codes, and 86316 is for another tumor antigen.
Does a CA 19-9 result diagnose cancer by itself?
No. Results may support assessment and monitoring in relevant cancers, but do not establish a cancer diagnosis on their own.
Is modifier 26 appropriate for 86301?
Medicare pays 86301 through the CLFS, not as a physician-fee-schedule professional interpretation service.
How does Medicare pay 86301?
Medicare pays one national CLFS amount per code across states and localities, with no office-versus-facility 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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