CPT code 86701: HIV-1 antibody, HIV-1-specific antibody2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This laboratory assay detects antibodies to HIV-1 and is reported when an HIV-1-specific antibody assay, rather than a combined HIV test, is performed.
Medicare pays $8.89 for 86701 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
$8.89
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
- QW · CLIA-waived test
- $8.89
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 86701 covers
86701 identifies laboratory analysis for antibodies directed against HIV-1. It distinguishes an HIV-1-specific antibody assay from a test reporting a combined HIV-1/HIV-2 antibody result and from a combined HIV antigen-and-antibody assay. Report the code when the test performed is the HIV-1 antibody analysis. HIV-1 antibody testing may be ordered as part of an evaluation for HIV infection.
Medicare pays 86701 through the CLFS, with one national amount applying in every state and locality and no office-versus-facility payment difference. The 2026 national CLFS amount is $8.89, unchanged since 2020. CMS lists a CLIA-waived version; modifier QW identifies that version for performance by a site holding a CLIA certificate of waiver. Report QW when billing the waived version.
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 86701
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 86701. 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 86701 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 86701 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $8.89.
86701 on the lab fee schedule since 2020
86701 · CLFS 2026 Q4 (current)
$8.89
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.
86701 compared with similar tests
- 86702HIV antibodyHIV-2-specific$13.52
- 86702 is for HIV-2 antibodies; 86701 is specific to HIV-1 antibodies.
- 86703HIV antibodyCombined, single result$13.71
- 86703 represents an HIV-1/HIV-2 antibody assay reported as one result. Use 86701 when the assay is specific to HIV-1 antibodies.
- 87389HIV screenHIV-1 antigen plus HIV-1/2 antibodies$24.08
- 87389 is for a combined HIV antigen-and-antibody assay; 86701 is for HIV-1 antibody analysis.
86701 billing questions
How does 86701 differ from an HIV-1/HIV-2 antibody test?
86701 reports antibodies to HIV-1 specifically. Use 86703 when the assay reports a combined HIV-1/HIV-2 antibody result.
When should modifier QW be reported?
Report QW for the CLIA-waived version when the testing site holds a CLIA certificate of waiver and performs that waived test.
Does Medicare pay 86701 under the physician fee schedule?
No. Medicare pays 86701 through the CLFS, with one national amount applying across localities and no office or facility payment difference.
Can 86701 be used for an HIV antigen-and-antibody assay?
No. This code is for HIV-1 antibody analysis; an assay that combines HIV antigen and antibody testing is a different service.
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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