CPT code 86769: COVID-19 antibody, multiple-step method2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This multiple-step test measures antibodies to SARS-CoV-2 and is reported for serology, including assessment of antibody response after infection or vaccination.
Medicare pays $42.13 for 86769 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
$42.13
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2022
- Unchanged
- QW · CLIA-waived test
- $42.13
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 86769 covers
86769 reports a laboratory measurement of antibodies to SARS-CoV-2 using a multiple-step method. Clinicians may order serology to assess whether a patient has developed an antibody response after infection or vaccination. Antibody detection is distinct from testing for current viral infection. Code 86328 describes the single-step SARS-CoV-2 antibody method.
Medicare pays 86769 only through the Clinical Laboratory Fee Schedule (CLFS). CMS sets one national amount for the code across states and localities, with no office-versus-facility payment difference. The 2026 national CLFS amount is $42.13, unchanged from 2022 through 2026. CMS lists a CLIA-waived version; use modifier QW when the waived test is performed at a site holding a CLIA certificate of waiver.
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 86769
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 86769. 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 86769 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 86769 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $42.13.
86769 on the lab fee schedule since 2020
86769 · CLFS 2026 Q4 (current)
$42.13
Unchanged since Jan 1, 2022
Every change on file
- Jan 1, 2022 · CLFS 2022 Q1MAC-priced → $42.13
26 quarterly CLFS releases on file, first CLFS 2020 Q3. A code missing from a quarter wasn’t on that release.
86769 compared with similar tests
- 86328COVID-19 antibodySingle-step immunoassay$45.28
- Choose 86769 for the multiple-step SARS-CoV-2 antibody method and 86328 for the single-step method.
- 87635COVID-19 testAmplified nucleic acid detection$51.31
- 86769 measures antibodies; 87635 detects SARS-CoV-2 nucleic acid.
- 87426Coronavirus antigenQualitative or semiquantitative$35.33
- 86769 measures antibodies; 87426 detects SARS-CoV-2 antigen.
86769 billing questions
How does 86769 differ from 86328?
86769 is for the multiple-step SARS-CoV-2 antibody method; 86328 is for the single-step method.
Does this test diagnose current COVID-19?
No. It measures antibodies, not the virus itself. Nucleic acid or antigen testing is used for direct detection of SARS-CoV-2.
When is modifier QW appropriate?
Use QW for the CLIA-waived version when it is performed at a site holding a CLIA certificate of waiver.
How does Medicare pay for 86769?
Medicare pays it through the CLFS at one national amount across localities, with no office-versus-facility payment difference.
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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