CPT code 86603: Adenovirus antibody, antibody analysis2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Adenovirus antibody testing evaluates the patient’s antibody response to this respiratory virus as part of a serologic workup for suspected infection.
Medicare pays $12.87 for 86603 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
$12.87
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 86603 covers
This serologic laboratory test analyzes a patient specimen for antibodies to adenovirus, a respiratory virus. It measures the antibody response, not the virus itself, and may be part of a clinician’s evaluation of suspected adenovirus infection. A laboratory performs the antibody analysis; the result is not a direct test for adenovirus in a respiratory specimen.
Report 86603 for adenovirus antibody analysis. Medicare pays the test only through the CLFS, with one national amount applying across all states and localities and no office or facility payment difference. The 2026 national CLFS amount is $12.87, unchanged since 2020. This service has no separate physician-fee-schedule payment for interpretation. An adenovirus antigen assay addresses a different target.
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 86603
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 86603. 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 86603 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86603 on the lab fee schedule since 2020
86603 · CLFS 2026 Q4 (current)
$12.87
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.
86603 compared with similar tests
- 87425Rotavirus testAntigen immunoassay$11.98
- This code detects adenovirus antigen directly. Choose 86603 when the test analyzes antibodies to adenovirus.
- 86644CMV antibodyGeneral antibody assay$14.39
- This code tests for cytomegalovirus antibodies. Use 86603 for antibodies to adenovirus.
- 86645CMV antibodyIgM antibody$16.85
- This code tests for cytomegalovirus IgM antibodies; 86603 targets adenovirus antibodies.
86603 billing questions
When should 86603 be chosen over an adenovirus antigen test?
Use 86603 when the laboratory analyzes the patient’s antibodies to adenovirus. An antigen test looks for adenovirus antigen directly in the specimen.
Does 86603 identify adenovirus in a respiratory specimen?
No. It measures the patient’s antibody response; it is not a direct respiratory-specimen test for the virus.
Is a separate modifier 26 service reported with 86603?
No separate physician interpretation payment is available for this test under the physician fee schedule. Medicare pays the laboratory test through the CLFS.
How does Medicare price 86603?
Medicare uses one national CLFS amount for the code across all states and localities, with no office or facility payment 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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