CPT code 86750: Malaria antibody, plasmodium-specific2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Laboratory antibody analysis for Plasmodium is reported for malaria-specific serology, distinguishing it from direct detection of the parasite.
Medicare pays $13.19 for 86750 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
$13.19
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 86750 covers
86750 is a laboratory antibody assay directed at Plasmodium, the parasite that causes malaria. The measured finding is the patient's antibody response, not the presence of Plasmodium organisms. Report this code when testing specifically targets malaria antibody; it is distinct from a generic protozoal antibody test or a direct parasite-detection service. This distinction separates 86750 from 86753, used for protozoal antibody testing designated NOS, and from Toxoplasma antibody codes 86777 and 86778, the latter identifying IgM testing.
Medicare pays 86750 only through the CLFS. The 2026 national CLFS amount is $13.19, unchanged since 2020. One national amount applies in every state and locality, without geographic or office/facility adjustment. The code is excluded from the physician fee schedule 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 86750
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 86750. 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 86750 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86750 on the lab fee schedule since 2020
86750 · CLFS 2026 Q4 (current)
$13.19
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.
86750 compared with similar tests
- 86753Protozoan antibodyNot otherwise specified$12.39
- Choose 86750 for antibodies to Plasmodium. Code 86753 is for protozoal antibody testing designated NOS.
- 86777Toxoplasma antibody$14.39
- 86777 concerns Toxoplasma antibodies, not malaria antibodies. Select according to the organism being tested.
- 86778Toxoplasma antibodyIgM antibody$14.41
- 86778 is the Toxoplasma IgM antibody test. It does not represent Plasmodium antibody testing.
86750 billing questions
When should 86750 be selected instead of 86753?
Use 86750 when the antibody target is Plasmodium. Code 86753 is for protozoal antibody testing designated NOS.
Does a positive malaria antibody result establish active malaria?
No. The test measures antibodies rather than Plasmodium organisms, so a positive result is not direct detection of the parasite.
How does 86750 differ from toxoplasma antibody testing?
86750 is specific to Plasmodium. Codes 86777 and 86778 concern Toxoplasma antibodies, with 86778 identifying the IgM test.
How does Medicare pay for 86750?
Medicare pays 86750 through the CLFS at one national amount across localities, with no office/facility payment difference. The code is excluded from the physician fee schedule.
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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