CPT code 86794: Zika antibody, igM specific2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Zika virus IgM antibody analysis is reported for laboratory evaluation of possible Zika infection, distinguishing it from other pathogen-specific antibody tests.
Medicare pays $16.85 for 86794 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
$16.85
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 7 sections
What 86794 covers
This laboratory serology analysis detects IgM antibodies directed against Zika virus. It is used in evaluating possible Zika virus infection; the result identifies an antibody response, not the virus itself. Clinical laboratories perform and report the test for the ordering clinician. The code distinguishes Zika-specific IgM testing from antibody testing for other pathogens and from tests that do not identify the virus.
Report 86794 for the Zika-specific IgM analysis. Medicare pays 86794 only through the CLFS. The 2026 national CLFS amount is $16.85, unchanged since 2020; one national amount applies across states and localities, with no geographic adjustment or office/facility difference. 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 86794
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 86794. 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 86794 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86794 on the lab fee schedule since 2020
86794 · CLFS 2026 Q4 (current)
$16.85
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.
86794 compared with similar tests
- 86788West Nile IgMIgM antibody$16.85
- Both report pathogen-specific IgM antibody testing. Use 86794 for Zika and 86788 for West Nile virus.
- 86789West Nile antibodyGeneral antibody assay$14.39
- 86789 reports West Nile virus antibody testing; 86794 reports Zika virus IgM antibody testing.
- 86790Virus antibodyVirus not otherwise specified$12.88
- 86790 is for virus antibody testing without a named virus. Use 86794 when the analysis targets Zika virus IgM.
86794 billing questions
What does 86794 test for?
It reports analysis for IgM antibodies to Zika virus. It is specific to Zika, not a general viral antibody test.
How does 86794 differ from 86788?
86794 is for Zika virus IgM antibody analysis; 86788 is for West Nile virus IgM antibody analysis. Select the code for the virus tested.
When is 86794 preferable to 86790?
Use 86794 for Zika-specific IgM antibody analysis. Code 86790 describes virus antibody testing without naming a specific virus.
How does Medicare pay for 86794?
Medicare pays the test through the CLFS only. The national amount applies across localities and does not vary between office and facility settings.
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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