CPT code 86361: CD4 count, absolute count only2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures the absolute number of CD4 T lymphocytes in blood, commonly to assess immune status and monitor people receiving HIV care.
Medicare pays $26.78 for 86361 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
$26.78
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 86361 covers
This test quantifies CD4 T lymphocytes, a T-cell subset used to assess immune status. Laboratories commonly use flow cytometry on peripheral blood. Clinicians, particularly those providing HIV care, use results to monitor immune function. Report this code for the absolute CD4 count; a service that includes the CD4/CD8 ratio is distinguished by 86360, while 86359 reports total T cells.
Report the laboratory test when an absolute CD4 count is performed and reported. Medicare pays the code only through the CLFS, at one national amount that applies across localities, without office or facility adjustment. The 2026 national CLFS amount is $26.78 and has remained unchanged from 2020 through 2026. The test is paid only from the CLFS, not under the physician fee schedule, so there is no separate physician interpretation payment for this code.
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 86361
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 86361. 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 86361 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86361 on the lab fee schedule since 2020
86361 · CLFS 2026 Q4 (current)
$26.78
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.
86361 compared with similar tests
- 86360T-cell countCD4, CD8, and ratio$46.98
- This code is for an absolute CD4 count. Choose 86360 when the reported service includes the CD4/CD8 ratio.
- 86359T-cell countTotal population$37.73
- 86359 measures total T cells, while this code measures the CD4 T-cell subset.
- 86355B-cell countB lymphocytes, total$37.73
- 86355 is for B-cell counts; this code is for absolute CD4 T-cell counts.
- 86357NK cell countTotal cell count$37.73
- 86357 is for natural killer cell counts; this code is for absolute CD4 T-cell counts.
86361 billing questions
How does this code differ from 86360?
Use 86361 for an absolute CD4 T-cell count. Code 86360 is associated with the CD4 count and CD4/CD8 ratio.
Is this the same as a total T-cell count?
No. This code reports the absolute CD4 subset count; 86359 reports total T cells.
What specimen and method are typical?
Laboratories commonly perform flow cytometry on peripheral blood to quantify CD4 T lymphocytes.
Does Medicare pay a separate physician interpretation for this code?
No. Medicare pays this code through the CLFS only; it has no separate physician-fee-schedule payment.
What should the laboratory documentation support?
The record should support that the test reported was an absolute CD4 T-cell count, rather than a total T-cell count or a count-and-ratio service.
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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