CPT code 86617: Lyme antibody, confirmatory assay2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Confirmatory antibody testing for Borrelia burgdorferi is reported when a Lyme serologic evaluation includes a confirmatory assay after initial testing.
Medicare pays $15.49 for 86617 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
$15.49
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 86617 covers
This test detects antibodies to Borrelia burgdorferi, the bacterium associated with Lyme disease, as a confirmatory laboratory assay. Methods may include Western blot or immunoblot. It is used within Lyme serologic evaluation when an initial antibody test is followed by confirmation. The initial and confirmatory assays serve different steps in that evaluation; report 86617 for the confirmatory assay, not for an initial antibody test alone. Clinical laboratories perform and report the assay for clinicians evaluating possible Lyme disease.
Medicare pays 86617 only through the CLFS. The 2026 national amount is $15.49 and has remained unchanged since 2020. The same national amount applies across states and localities, with no geographic adjustment or office-versus-facility difference. The test is excluded from 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 86617
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 86617. 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 86617 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86617 on the lab fee schedule since 2020
86617 · CLFS 2026 Q4 (current)
$15.49
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.
86617 compared with similar tests
- 86618Lyme antibodyLyme disease antibody$17.03
- Use 86618 for Lyme antibody testing that is not identified as confirmatory; use 86617 for the confirmatory assay, such as an immunoblot.
- 86619Borrelia antibodyRelapsing fever target$13.38
- 86619 is listed for Borrelia antibody testing without Lyme-specific confirmatory wording; 86617 identifies confirmatory testing for Borrelia burgdorferi.
86617 billing questions
When should 86617 be reported instead of 86618?
Report 86617 for the confirmatory Lyme antibody assay, such as an immunoblot. Use 86618 for Lyme antibody testing that is not identified as confirmatory.
Can 86617 be reported with 86618?
They may be reported in the same Lyme serologic evaluation when both the initial antibody test and a confirmatory test are performed.
What method is associated with 86617?
It is a confirmatory antibody test; methods may include Western blot or immunoblot.
How does Medicare pay for 86617?
Medicare pays it through the CLFS at one national amount, with no locality or office-versus-facility adjustment. The test is excluded from the physician fee schedule.
Should 86617 be reported for every Lyme antibody test?
No. Use it for a confirmatory test, not for an initial Lyme antibody test alone.
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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