CPT code 86592: Syphilis test, qualitative, nontreponemal2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A qualitative nontreponemal antibody test used to screen for syphilis or assess a patient’s serologic response during evaluation or follow-up.
Medicare pays $4.27 for 86592 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
$4.27
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 86592 covers
This laboratory test detects nontreponemal antibodies associated with syphilis. Common methods include RPR and VDRL. Clinicians order it when evaluating possible syphilis, and laboratories may perform it as part of an initial screening or follow-up assessment. A reactive result may lead to quantitative titer testing and treponemal antibody testing to support diagnosis and clinical interpretation.
Report 86592 for the qualitative nontreponemal test; use 86593 when the service measures a quantitative titer. Report the service performed rather than treating the qualitative and quantitative tests as interchangeable. Medicare pays this test only through the CLFS. The 2026 national CLFS amount is $4.27, unchanged since 2020; one amount applies across localities, with no office-versus-facility difference.
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 86592
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 86592. 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 86592 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86592 on the lab fee schedule since 2020
86592 · CLFS 2026 Q4 (current)
$4.27
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.
86592 compared with similar tests
- 86593Syphilis testQuantitative antibody test$4.40
- Report 86592 for a qualitative nontreponemal result; report 86593 when the laboratory determines and reports a quantitative titer.
- 86780Syphilis antibodyTreponemal antibody$13.24
- Code 86780 represents treponemal antibody testing. Code 86592 represents a nontreponemal test such as RPR or VDRL.
86592 billing questions
When should 86592 be reported instead of 86593?
Use 86592 when the nontreponemal result is qualitative. Use 86593 when the laboratory reports a quantitative titer.
Is this the same as a treponemal antibody test?
No. Code 86592 represents a qualitative nontreponemal test, such as RPR or VDRL. Treponemal antibody testing is reported with a different code, such as 86780.
Can a qualitative test and a titer both be reported?
They represent different testing services. Report each only when the laboratory performed both and the documentation supports both results.
How does Medicare pay for 86592?
Medicare pays 86592 from the CLFS at one national amount across localities, without an office-versus-facility payment difference.
What should the laboratory record support?
The record should identify the qualitative nontreponemal test performed and its result. If a quantitative titer or treponemal test was also performed, the record should support that distinct 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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