CPT code 86431: Rheumatoid factor, quantitative level2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures the level of rheumatoid factor in a patient’s blood sample to support evaluation of suspected rheumatoid arthritis and related inflammatory conditions.
Medicare pays $5.67 for 86431 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
$5.67
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 86431 covers
This test measures the level of rheumatoid factor, an autoantibody associated with rheumatoid arthritis and some other conditions. It is commonly ordered when a patient has joint pain, swelling, or stiffness and a clinician is evaluating possible inflammatory arthritis. Primary care clinicians and rheumatologists may order it; a clinical laboratory performs and reports the result, typically from a blood sample.
Report 86431 for a quantitative rheumatoid factor result; the qualitative test is a separate code. Medicare pays the test solely under the CLFS. The 2026 national CLFS amount is $5.67, unchanged since 2020. One national amount applies across states and localities, without geographic or office-versus-facility adjustment. The test has no separate physician fee schedule payment.
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 86431
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 86431. 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 86431 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86431 on the lab fee schedule since 2020
86431 · CLFS 2026 Q4 (current)
$5.67
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.
86431 compared with similar tests
- 86430Rheumatoid factorQualitative result$6.14
- 86431 reports a quantitative rheumatoid factor level; 86430 reports a qualitative result.
- 86200Anti-CCP testRheumatoid arthritis assessment$12.95
- 86200 measures cyclic citrullinated peptide antibodies, not rheumatoid factor. The tests may be ordered together but represent distinct antibody measurements.
- 86140CRP testStandard CRP assay$5.18
- 86140 measures C-reactive protein, an inflammation marker; it does not measure rheumatoid factor.
86431 billing questions
When should 86431 be used instead of 86430?
Use 86431 when the laboratory reports a quantitative rheumatoid factor level. Code 86430 is for a qualitative rheumatoid factor test.
Can rheumatoid factor and anti-CCP testing be reported together?
Yes. Rheumatoid factor and cyclic citrullinated peptide antibody testing measure different antibodies and may be ordered together when evaluating suspected rheumatoid arthritis.
What specimen is typically tested?
The test is typically performed on a blood sample, usually serum.
How does Medicare pay for 86431?
Medicare pays 86431 under the CLFS at one national amount, with no locality or office-versus-facility adjustment. It is paid solely through the CLFS.
Does a rheumatoid factor result establish rheumatoid arthritis?
No. Clinicians interpret the result alongside the patient’s symptoms, examination, and other laboratory findings.
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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