CPT code 86765: Measles antibody2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Laboratory analysis for antibodies to rubeola, or measles virus, reported when the requested antibody test targets measles.
Medicare pays $12.88 for 86765 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
$12.88
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 7 sections
What 86765 covers
Code 86765 reports a laboratory analysis for antibodies to rubeola, the measles virus. It identifies the viral target rather than a particular antibody class or assay method. The code is selected when the requested antibody analysis is for measles; it is distinct from testing for rubella antibodies. A rubella antibody test targets a different virus despite the similar names. Clinical laboratories perform and report the analysis in outpatient and hospital care.
Report 86765 for the rubeola antibody analysis. The 2026 national CLFS amount is $12.88, unchanged since 2020. Medicare pays one CLFS amount per code nationwide, without locality or office-versus-facility adjustment. The test is paid only through the CLFS and 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 86765
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 86765. 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 86765 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86765 on the lab fee schedule since 2020
86765 · CLFS 2026 Q4 (current)
$12.88
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.
86765 compared with similar tests
- 86762Rubella antibody$14.39
- Use 86765 for measles (rubeola) antibodies and 86762 for rubella antibodies. The similar names refer to different viruses and tests.
- 86787VZV antibody$12.88
- 86787 identifies antibodies to varicella-zoster virus, not measles. Choose according to the virus being tested.
- 86790Virus antibodyVirus not otherwise specified$12.88
- 86790 is for virus antibody testing without a more specific listed target. Use 86765 when the test specifically targets rubeola antibodies.
86765 billing questions
How does 86765 differ from the rubella antibody code?
86765 is for antibodies to rubeola, or measles virus. Use 86762 for antibodies to rubella, a different virus.
Does 86765 identify an IgG or IgM test?
The code identifies rubeola antibody testing, not a particular antibody class or assay method.
How does Medicare pay for 86765?
Medicare pays for the test through the CLFS. The code is excluded from the physician fee schedule by statute.
Does the CLFS payment vary by locality or setting?
No. Medicare pays one amount per code nationwide, without locality 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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