CPT code 86430: Rheumatoid factor, qualitative result2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Qualitative rheumatoid factor testing reports whether this autoantibody is detected during evaluation of suspected rheumatoid arthritis or related inflammatory disease.
Medicare pays $6.14 for 86430 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
$6.14
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 86430 covers
This laboratory assay looks for rheumatoid factor, an autoantibody that can be present in rheumatoid arthritis and other conditions. Clinicians commonly order it when evaluating joint pain, swelling, or other findings that raise concern for inflammatory arthritis. The result is qualitative, indicating whether rheumatoid factor is detected rather than reporting its measured concentration. It is one part of the clinical assessment, which may also include other antibody tests and markers of inflammation.
Report 86430 for the qualitative rheumatoid factor assay; use the quantitative sibling code when the service measures a level. Medicare pays this test only through the CLFS, with one national amount and no locality or office-versus-facility adjustment. The 2026 national CLFS amount is $6.14, unchanged since 2020. The code is excluded from the physician fee schedule, so payment is through the CLFS rather than a physician-fee-schedule service.
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 86430
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 86430. 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 86430 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86430 on the lab fee schedule since 2020
86430 · CLFS 2026 Q4 (current)
$6.14
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.
86430 compared with similar tests
- 86431Rheumatoid factorQuantitative level$5.67
- 86431 reports a quantitative rheumatoid factor level. Use 86430 when the laboratory result is qualitative.
- 86200Anti-CCP testRheumatoid arthritis assessment$12.95
- 86200 measures antibodies to cyclic citrullinated peptides, not rheumatoid factor. The tests assess different antibodies and may be ordered together.
- 86140CRP testStandard CRP assay$5.18
- 86140 measures C-reactive protein, an inflammation marker; it does not detect rheumatoid factor.
86430 billing questions
When should 86430 be reported instead of 86431?
Report 86430 when the assay provides a qualitative result indicating whether rheumatoid factor is detected. Use 86431 when the laboratory reports a quantitative rheumatoid factor level.
Does 86430 report an anti-CCP antibody test?
No. 86430 is for rheumatoid factor; anti-CCP antibody testing is a separate assay reported with 86200.
Does 86430 include an inflammatory marker such as ESR or CRP?
No. ESR and CRP are separate laboratory tests and are not part of the rheumatoid factor assay.
How does Medicare pay for 86430?
Medicare pays 86430 through the CLFS at one national amount, with no geographic or office-versus-facility adjustment. The code is excluded from the physician fee schedule.
Is modifier 26 used for 86430?
Medicare pays 86430 only through the CLFS; it is not a physician-fee-schedule 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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