CPT code 86619: Borrelia antibody, relapsing fever target2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reports serologic analysis for antibodies to relapsing-fever Borrelia, distinguishing it from Lyme disease antibody testing.
Medicare pays $13.38 for 86619 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
$13.38
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 86619 covers
This laboratory serology evaluates a patient sample for antibodies to Borrelia associated with relapsing fever. Its antibody target distinguishes the test from Lyme disease antibody testing, although both involve Borrelia. The result reflects an antibody response rather than direct detection of the organism. Clinical laboratories perform and report this analysis when testing for relapsing-fever Borrelia; code selection follows the target of the antibody assay, not a general label of Borrelia.
Report this code for the Borrelia antibody analysis performed, not for direct organism detection or Lyme disease antibody testing. Medicare pays the test only through the CLFS, at one nationally set amount across states and localities, with no office or facility payment difference. The 2026 national amount is $13.38, unchanged since 2020. The physician fee schedule excludes the test by statute, so payment is through the CLFS.
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 86619
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 86619. 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 86619 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86619 on the lab fee schedule since 2020
86619 · CLFS 2026 Q4 (current)
$13.38
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.
86619 compared with similar tests
- 86617Lyme antibodyConfirmatory assay$15.49
- Code 86617 is for confirmatory Lyme disease antibody testing. Use 86619 when the assay targets relapsing-fever Borrelia.
- 86618Lyme antibodyLyme disease antibody$17.03
- Code 86618 is for Lyme disease antibody testing. Use 86619 for antibodies to relapsing-fever Borrelia.
86619 billing questions
When should this code be selected instead of a Lyme disease antibody code?
Use this code when the assay targets relapsing-fever Borrelia. Codes 86617 and 86618 are for Lyme disease antibody testing.
Does this assay detect the bacteria directly?
No. It evaluates for antibodies to relapsing-fever Borrelia rather than directly detecting the organism.
How does Medicare pay this test?
Medicare pays it through the CLFS at one national amount across localities, with no office or facility payment difference.
Is there separate physician-fee-schedule payment for this code?
No. Medicare pays this test only through the CLFS; the physician fee schedule excludes it by statute.
What should distinguish this test from other Borrelia antibody testing?
The antibody target should be relapsing-fever Borrelia. Lyme disease antibody testing is reported with the code that matches that test.
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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