CPT code 86709: Hepatitis A, igM antibody2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures IgM antibody to hepatitis A virus, typically to evaluate suspected recent infection in a patient with compatible symptoms or exposure.
Medicare pays $11.26 for 86709 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
$11.26
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 86709 covers
This test measures IgM-class antibody to hepatitis A virus. Clinicians order it when evaluating suspected recent hepatitis A infection, including patients with compatible symptoms or a relevant exposure. Clinical laboratories perform the assay for outpatient and hospital-based testing; clinicians interpret the result with the patient’s history and other findings when assessing possible acute infection.
Report 86709 for hepatitis A IgM antibody testing, distinguishing it from the hepatitis A antibody test represented by 86708. Medicare pays the test only through the CLFS, at one national amount across states and localities, with no office-versus-facility difference. The 2026 national CLFS amount is $11.26, unchanged since 2020. The test is not paid under 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 86709
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 86709. 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 86709 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86709 on the lab fee schedule since 2020
86709 · CLFS 2026 Q4 (current)
$11.26
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.
86709 compared with similar tests
- 86708Hepatitis A antibodyTotal antibody$12.39
- 86709 is specific to IgM antibody and is used when recent hepatitis A infection is being evaluated. Code 86708 identifies a hepatitis A antibody test without that IgM-specific distinction.
- 86705Hepatitis B core antibodyIgM antibody$11.77
- 86705 measures IgM antibody to hepatitis B core antigen, not hepatitis A antibody. Select based on the virus being evaluated.
- 86704Core antibodyTotal antibody$12.05
- 86704 measures total hepatitis B core antibody. It differs from 86709 in both the virus and the antibody target.
86709 billing questions
When should 86709 be selected instead of 86708?
Use 86709 for the IgM-class hepatitis A antibody assay when evaluating suspected recent infection. Code 86708 identifies a hepatitis A antibody test without the IgM-specific distinction.
Is physician interpretation separately reported with 86709?
Medicare pays 86709 only through the CLFS; it is excluded from the physician fee schedule.
How does Medicare set payment for 86709?
Medicare pays one national CLFS amount for the code, regardless of state, locality, or office versus facility setting.
Does 86709 represent total hepatitis A antibody testing?
No. It identifies the IgM-class assay; 86708 is the hepatitis A antibody test without the IgM-specific distinction.
How is 86709 different from 86705?
Code 86709 tests IgM antibody to hepatitis A virus; 86705 tests IgM antibody to hepatitis B core antigen. The virus and antibody target determine the appropriate code.
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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