CPT code 86628: Candida antibody, antibody to Candida2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This laboratory test analyzes antibody to Candida yeast and is reported when a Candida-specific antibody assay is performed.
Medicare pays $12.01 for 86628 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
$12.01
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 7 sections
What 86628 covers
Code 86628 identifies laboratory analysis for antibody to Candida, a yeast. The result concerns antibody directed against Candida, rather than an antibody test directed at Aspergillus, Coccidioides, or Cryptococcus. Report it for the Candida antibody analysis itself. The code identifies the organism target; it does not describe Candida culture, antigen testing, or molecular identification.
Medicare pays 86628 through the Clinical Laboratory Fee Schedule (CLFS), not the physician fee schedule. CLFS uses one national amount for this code across states and localities, with no geographic adjustment or office-versus-facility difference. The 2026 national amount is $12.01, unchanged since 2020. Payment is tied to the code's CLFS amount regardless of locality or office/facility setting for this assay.
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 86628
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 86628. 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 86628 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86628 on the lab fee schedule since 2020
86628 · CLFS 2026 Q4 (current)
$12.01
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.
86628 compared with similar tests
- 86606Aspergillus antibody$15.05
- 86606 is for Aspergillus antibody testing. Use 86628 for an assay targeting Candida.
- 86635Coccidioides antibodySerologic test$11.47
- 86635 is for Coccidioides antibody testing; 86628 targets Candida.
- 86641Cryptococcus antibody$14.41
- 86641 is for Cryptococcus antibody testing; 86628 targets Candida.
86628 billing questions
What does 86628 measure?
It analyzes antibody to Candida, a yeast. The code identifies Candida as the antibody target.
Does 86628 detect Candida organisms directly?
No. It is an antibody analysis, not a culture or direct organism-identification test.
How is 86628 different from 86606?
86628 is for antibody to Candida; 86606 is for antibody to Aspergillus. Select the code for the organism targeted by the antibody test.
How does Medicare pay for 86628?
Medicare pays it through the CLFS. The national amount applies across localities and does not vary by office or facility setting.
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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