CPT code 86803: Hepatitis C antibody, screening antibody assay2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures hepatitis C antibodies in a blood specimen for screening or evaluation; a reactive result alone does not establish current infection.
Medicare pays $14.27 for 86803 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
$14.27
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
- $14.27
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 86803 covers
This serologic test detects antibodies to hepatitis C virus, commonly in serum or plasma. Clinicians order it to screen for HCV exposure or evaluate possible prior infection. A reactive result can reflect current or past exposure, including infection that cleared or was treated, and does not establish active infection. HCV RNA testing can assess whether virus is currently present. Clinical laboratories perform the assay, with waived testing available at eligible sites.
Report the antibody test performed; use modifier QW for the CLIA-waived version when the testing site holds a CLIA certificate of waiver. Medicare pays the test through the CLFS. The 2026 national CLFS amount is $14.27, unchanged from 2020 through 2026. That amount applies nationwide, without locality or office-versus-facility adjustment.
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 86803
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 86803. 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 86803 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 86803 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $14.27.
86803 on the lab fee schedule since 2020
86803 · CLFS 2026 Q4 (current)
$14.27
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.
86803 compared with similar tests
- 86804Hepatitis C antibodyConfirmatory testing$15.49
- 86803 is used for HCV antibody testing; 86804 is for confirmatory antibody testing when that procedure is performed.
- 87522HCV viral loadQuantitative RNA$42.84
- 86803 detects antibodies that can reflect HCV exposure. Code 87522 measures HCV RNA quantitatively to assess current viral presence.
- 87521HCV RNA testAmplified probe$35.09
- 86803 detects the immune response to HCV, while 87521 qualitatively tests for HCV RNA.
86803 billing questions
When should 86803 be reported instead of 86804?
Use 86803 for HCV antibody testing. Code 86804 is for confirmatory antibody testing when that distinct procedure is performed.
Does a reactive antibody result establish current hepatitis C infection?
No. A reactive result can reflect current or past exposure and does not establish active infection; HCV RNA testing assesses whether virus is currently present.
When is modifier QW appropriate?
Use QW for the CLIA-waived version when the site performing the test holds a CLIA certificate of waiver.
Does Medicare pay 86803 under the physician fee schedule?
No. Medicare pays this laboratory test through the CLFS, using one national amount across localities and settings.
Which test assesses whether HCV is currently present?
HCV RNA testing assesses current viral presence. Code 87522 is quantitative, while 87521 is qualitative.
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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