CPT code 86704: Core antibody, total antibody2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures total antibody to hepatitis B core antigen to assess prior or current natural HBV infection, often alongside surface antigen and surface antibody testing.
Medicare pays $12.05 for 86704 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
$12.05
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 86704 covers
This serology test measures total antibody to hepatitis B core antigen, including IgM and IgG without reporting them separately. A positive result can reflect current or past natural hepatitis B infection; vaccination alone does not produce core antibody. Clinicians order it for hepatitis B screening and to help evaluate possible infection, interpreting it with other hepatitis B markers. Testing is typically performed by a clinical laboratory on a patient specimen such as serum.
Report 86704 for the total core antibody measurement; use the IgM-specific code when the order calls for that distinct result. The test is paid under the Medicare CLFS, with one national amount applying across states and localities and no office or facility difference. The 2026 national CLFS amount is $12.05, unchanged since 2020. Medicare pays this test through the CLFS rather than 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 86704
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 86704. 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 86704 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86704 on the lab fee schedule since 2020
86704 · CLFS 2026 Q4 (current)
$12.05
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.
86704 compared with similar tests
- 86705Hepatitis B core antibodyIgM antibody$11.77
- 86704 reports total hepatitis B core antibody. 86705 is for the IgM-specific core antibody result.
- 86706Surface antibodyHepatitis B$10.74
- 86706 measures hepatitis B surface antibody, used to assess immunity; 86704 measures core antibody associated with natural exposure.
- 87340HBsAg testSurface antigen immunoassay$10.33
- 87340 detects hepatitis B surface antigen, a marker of current infection; 86704 measures the patient's total core antibody response.
- 86707Hepatitis B antibodyAnti-HBe$11.57
- 86707 measures hepatitis B e antibody. It is a different viral marker from the total core antibody measured by 86704.
86704 billing questions
When should 86704 be used instead of 86705?
Use 86704 for total hepatitis B core antibody. Use 86705 when the ordered test specifically measures the IgM core antibody.
Does a positive total core antibody indicate vaccine immunity?
No. Core antibody reflects natural exposure to hepatitis B; vaccination alone produces surface antibody, not core antibody. Interpret the result with other hepatitis B markers.
How does 86704 differ from the hepatitis B surface antibody test?
86704 measures antibody to the core antigen and helps identify natural infection. Code 86706 measures surface antibody, which can indicate immunity after vaccination or infection.
How does Medicare pay for 86704?
Medicare pays 86704 under the CLFS at one national amount across localities, with no office or facility difference. It is paid through the CLFS rather than the physician fee schedule.
Can 86704 be reported with other hepatitis B markers?
Yes. When separately ordered and performed, total core antibody may be reported with markers such as hepatitis B surface antigen or surface antibody to assess infection and immunity.
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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