CPT code 86703: HIV antibody, combined, single result2026 Medicare lab fee · Clinical Laboratory Fee Schedule
HIV-1/HIV-2 antibody testing reports one combined antibody result when the assay evaluates both virus types without an antigen component.
Medicare pays $13.71 for 86703 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
$13.71
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 86703 covers
86703 represents laboratory analysis for antibodies to both HIV-1 and HIV-2, reported as one result. Select it when the performed assay evaluates both virus types together and measures antibodies only. It differs from HIV-1-only antibody testing (86701), HIV-2-only antibody testing (86702), and combined HIV antigen-and-antibody testing (87389). Report the code that matches the assay performed; combined virus scope alone does not make an antigen-and-antibody assay an 86703 service.
Report one unit for the combined antibody test that produces one result. Medicare pays 86703 through the CLFS only. CMS sets one national amount that applies across localities, with no geographic or office-versus-facility adjustment. The 2026 national CLFS amount is $13.71, unchanged from 2020 through 2026. The physician fee schedule excludes the test by statute.
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 86703
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 86703. 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 86703 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86703 on the lab fee schedule since 2020
86703 · CLFS 2026 Q4 (current)
$13.71
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.
86703 compared with similar tests
- 86701HIV-1 antibodyHIV-1-specific antibody$8.89
- Use 86701 when the antibody assay targets HIV-1 alone. Use 86703 when the assay evaluates HIV-1 and HIV-2 together and reports one result.
- 86702HIV antibodyHIV-2-specific$13.52
- Use 86702 for HIV-2 antibody testing alone; 86703 represents combined HIV-1 and HIV-2 antibody testing with a single result.
- 87389HIV screenHIV-1 antigen plus HIV-1/2 antibodies$24.08
- Use 87389 for a combined assay that detects HIV antigen as well as HIV antibodies. Code 86703 represents antibody testing only.
86703 billing questions
Does 86703 include HIV antigen testing?
No. It represents antibody testing. A combined HIV antigen-and-antibody assay is represented by 87389.
How does 86703 differ from 86701 and 86702?
86703 is for an assay evaluating antibodies to both HIV-1 and HIV-2 with one result. 86701 and 86702 are for HIV-1-only and HIV-2-only antibody testing, respectively.
How many units are reported?
Report one unit for the combined antibody test that produces one result. Do not report separate 86701 and 86702 units for that same combined assay.
How does Medicare pay for 86703?
Medicare pays it through the CLFS at one national amount across localities, without geographic or office-versus-facility adjustment.
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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