CPT code 86328: COVID-19 antibody, single-step immunoassay2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A single-step immunoassay detects qualitative or semiquantitative antibodies to SARS-CoV-2 and is reported for COVID-19 antibody testing.
Medicare pays $45.28 for 86328 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
$45.28
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
- Unchanged
- QW · CLIA-waived test
- $45.28
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 86328 covers
86328 identifies a SARS-CoV-2 antibody immunoassay performed using a single-step method, including reagent-strip-style testing. The result is qualitative or semiquantitative and concerns antibodies, not direct detection of SARS-CoV-2. The code distinguishes this SARS-CoV-2-specific assay from broader infectious-agent antibody testing and from tests that detect viral material.
Report 86328 when the performed assay is the single-step SARS-CoV-2 antibody service. Modifier QW identifies the CLIA-waived version, which may be performed by a site holding a CLIA certificate of waiver. Medicare pays the test only through the CLFS, at one national amount across localities with no office or facility difference. The 2026 national CLFS amount is $45.28, unchanged from 2022 through 2026. The test is excluded from 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 86328
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 86328. 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 86328 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 86328 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $45.28.
86328 on the lab fee schedule since 2020
86328 · CLFS 2026 Q4 (current)
$45.28
Unchanged since Jan 1, 2022
Every change on file
- Jan 1, 2022 · CLFS 2022 Q1MAC-priced → $45.28
26 quarterly CLFS releases on file, first CLFS 2020 Q3. A code missing from a quarter wasn’t on that release.
86328 compared with similar tests
- 86769COVID-19 antibodyMultiple-step method$42.13
- Both concern SARS-CoV-2 antibodies. 86328 identifies the single-step immunoassay; select the code representing the service performed.
- 86318Infectious antibodySingle-step qualitative or semiquantitative$18.09
- 86318 is a broader infectious-agent antibody code. 86328 specifically identifies the single-step SARS-CoV-2 antibody immunoassay.
- 87635COVID-19 testAmplified nucleic acid detection$51.31
- 87635 detects viral material using a molecular test. 86328 detects antibodies to SARS-CoV-2.
86328 billing questions
When should 86328 be selected instead of 86769?
86328 identifies a single-step SARS-CoV-2 antibody immunoassay. 86769 is a separate code for SARS-CoV-2 antibody testing; select the code that represents the performed service.
How does 86328 differ from 86318?
86318 is a broader infectious-agent antibody code. 86328 specifically identifies the single-step antibody immunoassay for SARS-CoV-2.
Does 86328 detect the virus itself?
No. It detects antibodies to SARS-CoV-2. A molecular test such as 87635 detects viral material.
When is modifier QW appropriate?
QW identifies the CLIA-waived version for performance by a site holding a CLIA certificate of waiver.
How does Medicare pay for 86328?
Medicare pays it through the CLFS at one national amount across localities, with no office or 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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