CPT code 86789: West Nile antibody, general antibody assay2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reports laboratory testing for antibodies to West Nile virus, distinguished from the virus-specific IgM antibody test reported with CPT 86788.
Medicare pays $14.39 for 86789 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
$14.39
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 86789 covers
CPT 86789 reports laboratory analysis for antibodies to West Nile virus. It concerns the antibody response to a named viral target, rather than direct detection of West Nile virus. It is distinct from CPT 86788, which identifies West Nile virus IgM antibody testing; select between them according to whether the assay is general West Nile antibody testing or specifically an IgM assay. The code applies to the laboratory analysis performed and reported for West Nile antibody testing.
Medicare pays CPT 86789 only through the CLFS. CMS sets one national amount for all states and localities, without geographic adjustment or an office-versus-facility payment difference. The 2026 national CLFS amount is $14.39, unchanged since 2020. The test has no separate physician-fee-schedule payment or professional interpretation component.
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 86789
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 86789. 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 86789 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86789 on the lab fee schedule since 2020
86789 · CLFS 2026 Q4 (current)
$14.39
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.
86789 compared with similar tests
- 86788West Nile IgMIgM antibody$16.85
- Choose 86788 for an IgM-specific West Nile antibody assay. Use 86789 for general West Nile antibody testing.
- 86790Virus antibodyVirus not otherwise specified$12.88
- 86790 is for virus antibody testing not otherwise specified. Use 86789 when the test specifically targets West Nile virus.
- 86794Zika antibodyIgM specific$16.85
- 86794 reports Zika virus IgM antibody testing; 86789 reports West Nile virus antibody testing. Select the code matching the virus and assay ordered.
86789 billing questions
How does 86789 differ from 86788?
86789 identifies general West Nile virus antibody testing. Use 86788 when the assay specifically measures West Nile virus IgM.
Does this code test directly for West Nile virus?
No. It reports antibody analysis, not direct detection of the virus.
How does 86789 differ from 86790?
86790 is for virus antibody testing not otherwise specified. Use 86789 when the antibody test specifically targets West Nile virus.
How does Medicare pay for this test?
Medicare pays 86789 through the CLFS using one national amount across states and 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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