CPT code 86778: Toxoplasma antibody, igM antibody2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This serologic test detects IgM antibodies to Toxoplasma and may be ordered when evaluating suspected recent infection, including during pregnancy.
Medicare pays $14.41 for 86778 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
$14.41
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 86778 covers
Code 86778 represents a serologic test for IgM antibodies directed against Toxoplasma gondii, the parasite that causes toxoplasmosis. The laboratory tests a patient specimen, commonly serum, for an IgM response; it does not detect the parasite itself. Clinicians may order it when evaluating suspected toxoplasmosis, including during pregnancy or assessment of possible congenital infection. IgM findings require clinical interpretation because they may persist after infection and do not, by themselves, establish when infection occurred. A Toxoplasma antibody test reported with 86777 may be used alongside IgM testing to characterize the antibody response.
Report 86778 for the Toxoplasma IgM assay, rather than for a general Toxoplasma antibody result or a different organism’s serology. Medicare pays it only through the CLFS, at one nationally set amount without locality or office-versus-facility variation. The 2026 national CLFS amount is $14.41, unchanged since 2020. The test 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 86778
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 86778. 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 86778 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86778 on the lab fee schedule since 2020
86778 · CLFS 2026 Q4 (current)
$14.41
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.
86778 compared with similar tests
- 86777Toxoplasma antibody$14.39
- Choose 86778 when the assay specifically measures Toxoplasma IgM. Code 86777 identifies a Toxoplasma antibody test without that IgM-specific designation.
- 86753Protozoan antibodyNot otherwise specified$12.39
- Code 86753 is for antibody testing against protozoa when the target is not specified as Toxoplasma; 86778 identifies Toxoplasma IgM.
86778 billing questions
How does 86778 differ from 86777?
86778 identifies the IgM antibody assay for Toxoplasma. Use 86777 for a Toxoplasma antibody result that is not specifically reported as IgM.
Does a positive IgM result establish when infection occurred?
No. IgM antibodies can persist after infection, so the result alone does not establish the timing of infection.
What if the test is for an unspecified protozoan antibody?
Code 86753 describes protozoa antibody testing when the target is not specified as Toxoplasma. It is not a substitute when the assay specifically measures Toxoplasma IgM.
How does Medicare pay for 86778?
Medicare pays the test through the CLFS at one national amount, with no locality or office-versus-facility adjustment. It is excluded from the physician fee schedule by statute.
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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