CPT code 86780: Syphilis antibody, treponemal antibody2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures antibodies to Treponema pallidum for syphilis screening or evaluation, including treponemal testing used in traditional and reverse-sequence workflows.
Medicare pays $13.24 for 86780 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
$13.24
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
- QW · CLIA-waived test
- $13.24
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 86780 covers
This test detects antibodies to Treponema pallidum, the bacterium that causes syphilis; it does not detect the organism itself. Clinical laboratories commonly perform it on a patient specimen, usually serum, for syphilis screening or diagnostic evaluation. A treponemal assay may be the initial test in a reverse-sequence workflow or may follow a reactive nontreponemal result. Because treponemal antibodies can remain detectable after treatment, the result is interpreted with the patient’s history and other syphilis testing rather than as a measure of disease activity by itself.
Report 86780 for the treponemal antibody assay performed, not for each antibody detected. CMS recognizes a QW version for testing performed using a CLIA-waived method at a site with a certificate of waiver. Medicare pays this test only under the CLFS; the 2026 national CLFS amount is $13.24, unchanged since 2020. The same amount applies across states and localities, with no geographic or office-versus-facility adjustment. The physician fee schedule does not separately pay the test.
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 86780
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 86780. 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 86780 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 86780 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $13.24.
86780 on the lab fee schedule since 2020
86780 · CLFS 2026 Q4 (current)
$13.24
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.
86780 compared with similar tests
- 86592Syphilis testQualitative, nontreponemal$4.27
- Use 86592 for a qualitative nontreponemal syphilis test, such as an RPR or VDRL. Use 86780 for a treponemal antibody assay.
- 86593Syphilis testQuantitative antibody test$4.40
- Use 86593 when a nontreponemal syphilis test is performed quantitatively, typically to report a titer. It does not describe a treponemal antibody assay.
86780 billing questions
How does 86780 differ from an RPR or VDRL?
86780 reports a treponemal antibody assay. RPR and VDRL are nontreponemal tests, which are commonly used for screening and for following titers during syphilis care.
When is 86780 used in a syphilis testing algorithm?
It may be the initial assay in a reverse-sequence workflow or may be performed after a reactive nontreponemal result. Report the test actually performed in the laboratory’s algorithm.
Can 86780 and an RPR or VDRL be reported together?
When both distinct tests are performed in the same evaluation, report each under its own code: 86780 for the treponemal assay and 86592 or 86593 for qualitative or quantitative nontreponemal testing.
When should modifier QW be appended?
Use QW when the test is performed using a CLIA-waived method at a site holding a CLIA certificate of waiver. Do not append it solely because the assay detects Treponema pallidum antibodies.
How many units should be reported?
Report the assay performed as one service; do not base units on antibody concentration or the result value.
How does Medicare pay for 86780?
Medicare pays the test through the CLFS at one national amount across localities and settings. The physician fee schedule does not separately pay the test.
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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