CPT code 86316: Tumor marker, quantitative, each antigen2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A quantitative immunoassay used to detect a tumor antigen, reported for each antigen tested when no more specific tumor-marker code describes it.
Medicare pays $20.81 for 86316 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 86316 covers
This code reports a quantitative immunoassay used to detect a tumor antigen when no more specific tumor-marker code describes the antigen. Examples include CA 50, CA 72-4, and CA 549. The assay measures the identified antigen, and the code is reported for each antigen tested rather than for a group of different markers. The test order and laboratory report should identify the antigen measured and its quantitative result.
Report one unit for each antigen tested. Select a marker-specific code when the tested antigen is represented by one, such as the codes for CA 15-3, CA 19-9, or CA 125. Medicare pays 86316 only through the CLFS, at one national amount across states and localities without geographic or office/facility adjustment. The 2026 national CLFS amount is $20.81, unchanged from 2020 through 2025. The test is excluded from the physician fee schedule and paid only from the CLFS.
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 86316
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 86316. 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 86316 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86316 on the lab fee schedule since 2020
86316 · 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.
86316 compared with similar tests
- 86300Tumor markerCA 15-3 quantitative assay$20.81
- Use 86300 for a CA 15-3 immunoassay. Use 86316 for another tumor antigen, such as CA 50, CA 72-4, or CA 549, when no more specific code describes it.
- 86301CA 19-9Quantitative tumor antigen$20.81
- Use 86301 for CA 19-9 testing. Use 86316 for other tumor antigens rather than this specifically coded marker.
- 86304CA 125Quantitative tumor antigen$20.81
- Use 86304 for CA 125 testing. Use 86316 for other quantitatively measured tumor antigens when no more specific code describes them.
- 86317Infectious antibodyQuantitative measurement$14.99
- 86317 reports an immunoassay for an infectious agent; 86316 reports an immunoassay for a tumor antigen.
86316 billing questions
When should 86316 be used instead of a specific tumor-marker code?
Use 86316 for a quantitative tumor-antigen immunoassay when no more specific tumor-marker code describes the tested antigen. Examples include CA 50, CA 72-4, and CA 549.
How many units should be reported?
Report one unit for each antigen tested. The code represents each antigen, not a group of different markers.
What should the test order and report identify?
They should identify the antigen measured and its quantitative result so the assay can be distinguished from tests with their own specific codes.
How does Medicare pay for 86316?
Medicare pays it through the CLFS at one national amount across states and localities, with no geographic or office/facility adjustment.
Is 86316 paid under the physician fee schedule?
No. The test is paid only through the CLFS.
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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