CPT code 86804: Hepatitis C antibody, confirmatory testing2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A supplemental hepatitis C antibody test evaluates a reactive screening result and is reported separately from screening or HCV RNA testing.
Medicare pays $15.49 for 86804 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
$15.49
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 86804 covers
This laboratory test uses a supplemental antibody method, such as an immunoblot, to evaluate a reactive hepatitis C antibody screening result. It is generally performed by a clinical laboratory on a blood specimen. A positive antibody result does not establish current viremia; HCV RNA testing assesses whether virus is present. This test is distinct from the initial antibody screen and from nucleic acid testing.
Report 86804 for the confirmatory antibody service performed, rather than for the screening assay or an HCV RNA test. Medicare pays it through the CLFS, with one national amount applying across states and localities and no office-versus-facility difference. The 2026 national CLFS amount is $15.49, unchanged since 2020. The test is paid only from the CLFS and has no separate physician fee schedule payment.
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 86804
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 86804. 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 86804 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86804 on the lab fee schedule since 2020
86804 · CLFS 2026 Q4 (current)
$15.49
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.
86804 compared with similar tests
- 86803Hepatitis C antibodyScreening antibody assay$14.27
- 86803 is the hepatitis C antibody screen; 86804 is the supplemental antibody test used to evaluate a reactive screen.
- 87522HCV viral loadQuantitative RNA$42.84
- 87522 detects and quantifies HCV RNA to assess current viremia. 86804 evaluates antibody reactivity and does not determine whether virus is currently present.
- 87521HCV RNA testAmplified probe$35.09
- 87521 detects HCV nucleic acid using an amplified-probe method, whereas 86804 is supplemental antibody testing.
86804 billing questions
How does 86804 differ from 86803?
86803 reports the hepatitis C antibody screening test. Use 86804 for a supplemental antibody test performed to evaluate a reactive screening result.
Does a positive 86804 result establish active hepatitis C infection?
No. A positive antibody result does not establish current viremia; HCV RNA testing assesses whether virus is present.
Do 86803 and 86804 describe the same test?
No. 86803 is the initial antibody screen, while 86804 is a supplemental antibody confirmation test.
Is 86804 paid under the physician fee schedule?
No. Medicare pays this laboratory test through the CLFS, with a single national amount across localities and no office-versus-facility difference.
Should 86804 be used for an HCV RNA test?
No. 86804 is for supplemental antibody testing; use the applicable HCV nucleic acid code when the service detects viral RNA.
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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