CPT code 86790: Virus antibody, virus not otherwise specified2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Laboratories report this code for antibody analysis directed at a virus when no more specific virus-antibody code describes the test performed.
Medicare pays $12.88 for 86790 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 8 sections
What 86790 covers
This analysis detects antibodies directed against a viral target, while the code is used when no more specific virus-antibody code describes the test. A clinical laboratory reports the assay result for a test ordered by a treating clinician. The code is not a substitute for a dedicated code when one describes the test; select the code based on the antibody analysis and viral target performed.
Report 86790 for the analysis when its target does not fit a more specific virus-antibody code. Medicare pays the test through the CLFS using one nationally set amount across localities, without geographic or office-versus-facility adjustment. The 2026 national amount is $12.88, unchanged from 2020 through 2026. Payment is through the CLFS only, rather than the physician fee schedule.
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 86790
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 86790. 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 86790 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86790 on the lab fee schedule since 2020
86790 · 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.
86790 compared with similar tests
- 86769COVID-19 antibodyMultiple-step method$42.13
- Use 86769 for SARS-CoV-2 antibody testing. Use 86790 when no more specific virus-antibody code describes the test.
- 86789West Nile antibodyGeneral antibody assay$14.39
- Use 86789 for West Nile virus antibody testing. Use 86790 when no more specific virus-antibody code describes the test.
- 86756RSV antibodySerologic testing$15.89
- Use 86756 for a respiratory-virus antibody test described by that code; 86790 is for a virus-antibody analysis without a more specific code.
86790 billing questions
When should 86790 be used instead of a virus-specific antibody code?
Use 86790 when no more specific virus-antibody code describes the antibody analysis performed. Choose the dedicated code when it describes the viral target and test.
What does this test detect?
It detects antibodies directed against a virus. The code itself does not name the viral target.
What documentation supports reporting 86790?
Document the antibody analysis performed and its viral target. Use a dedicated virus-specific code when one describes the test.
How does Medicare pay for 86790?
Medicare pays the test through the CLFS at one national amount, with no locality or office-versus-facility adjustment. Payment is through the CLFS only.
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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