CPT code 86612: Blastomyces antibody2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Laboratory antibody analysis for Blastomyces is reported when a clinician orders testing to evaluate possible blastomycosis.
Medicare pays $12.90 for 86612 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
$12.90
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 86612 covers
CPT 86612 identifies laboratory analysis for antibodies to Blastomyces, a fungus associated with blastomycosis. As a serologic test, it evaluates the patient's antibody response rather than directly detecting the organism. A clinician may order it while assessing possible blastomycosis, and a clinical laboratory performs and reports the analysis to the ordering provider.
Report 86612 for the Blastomyces antibody analysis performed. Medicare pays 86612 through the Clinical Laboratory Fee Schedule (CLFS), using one national amount that applies in every state and locality with no geographic or office/facility adjustment. The 2026 national CLFS amount is $12.90, unchanged since 2020. Medicare pays this test only through the CLFS, not the physician fee schedule.
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 86612
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 86612. 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 86612 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86612 on the lab fee schedule since 2020
86612 · CLFS 2026 Q4 (current)
$12.90
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.
86612 compared with similar tests
- 86635Coccidioides antibodySerologic test$11.47
- 86635 is directed at Coccidioides antibodies; 86612 is for Blastomyces antibodies.
- 86606Aspergillus antibody$15.05
- 86606 identifies Aspergillus antibody testing, not Blastomyces antibody testing.
- 86641Cryptococcus antibody$14.41
- 86641 is for Cryptococcus antibody analysis. Choose 86612 when the test targets Blastomyces.
86612 billing questions
When should 86612 be selected instead of another fungal antibody code?
Use 86612 when the laboratory test targets antibodies to Blastomyces. Select a different organism-specific code when the test targets another fungus.
Does 86612 include a fungal culture or antigen test?
86612 identifies antibody analysis, not culture or antigen testing. Report those services using their applicable codes when performed.
What documentation supports reporting 86612?
The order and laboratory report should identify a Blastomyces antibody analysis. A general evaluation for fungal infection alone does not establish that this specific test was performed.
How does Medicare pay for 86612?
Medicare pays it through the CLFS using one national amount across localities, with no office or facility adjustment. The service is paid only through the CLFS.
Which organism does 86612 antibody testing target?
It targets antibodies to Blastomyces. It is not the code for antibody testing directed at another organism.
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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