CPT code 86609: Bacterial antibody, no organism-specific code2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This serology test detects antibodies to a bacterium not represented by a more specific organism code, when that antibody assay is performed.
Medicare pays $12.88 for 86609 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
$12.88
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 86609 covers
This test measures antibodies directed against a bacterium that is not identified by a more specific organism-targeted antibody code. It evaluates the patient’s antibody response rather than directly detecting the bacterium. A clinical laboratory performs the assay on a specimen submitted for serologic testing, typically as part of an infectious disease evaluation. The code is selected based on the antibody assay actually performed, not simply because a bacterial infection is suspected.
Report the code when the performed antibody assay targets a bacterium without a more specific organism code; use the organism-specific code when the assay targets an organism with its own code. Medicare pays the test through the Clinical Laboratory Fee Schedule (CLFS), and it is excluded from the physician fee schedule. The 2026 national CLFS amount is $12.88, unchanged since 2020. The same CLFS amount applies in every locality, with no office or 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 86609
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 86609. 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 86609 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86609 on the lab fee schedule since 2020
86609 · CLFS 2026 Q4 (current)
$12.88
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.
86609 compared with similar tests
- 86611Bartonella antibody$10.18
- Report 86611 when the antibody assay targets Bartonella. Use 86609 for a bacterial antibody assay without a more specific organism code.
- 86615Bordetella antibodyAntibody analysis$13.19
- Report 86615 for a Bordetella antibody assay. Code 86609 describes a bacterial antibody assay that lacks a more specific organism code.
- 86622Brucella antibodyBrucella-specific serology$8.93
- Use 86622 when testing for Brucella antibodies; use 86609 when the assay target is not represented by a specific organism code.
86609 billing questions
When should this code be chosen instead of an organism-specific antibody code?
Use it when the performed antibody assay targets a bacterium without a more specific organism code in this series. For a named target such as Bartonella or Bordetella, use the corresponding organism-specific code.
Does this test identify the bacterium itself?
No. It measures antibodies directed against a bacterium, not the bacterium itself.
What documentation supports reporting this code?
Document the antibody assay performed and the bacterial target tested. The record should support why this nonspecific-target code, rather than an organism-specific code, describes the service.
How does Medicare pay this laboratory test?
Medicare pays it through the CLFS. The national amount is the same across localities and does not differ between office and facility settings.
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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