CPT code 86812: HLA typing, single HLA-A, B, or C antigen2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Single-antigen HLA-A, HLA-B, or HLA-C typing supports immunologic evaluation, including HLA-B27 testing for suspected spondyloarthritis.
Medicare pays $25.81 for 86812 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
$25.81
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 86812 covers
This laboratory test identifies a single HLA-A, HLA-B, or HLA-C antigen for immunologic evaluation. HLA-B27 is a familiar example and may be ordered during evaluation of suspected spondyloarthritis; results are considered with clinical findings. Rheumatology practices may order the test, which is performed and reported by a clinical laboratory. The single-antigen scope distinguishes this service from typing multiple antigens in the A, B, or C groups.
Report 86812 for typing one antigen in HLA-A, HLA-B, or HLA-C; report 86813 when multiple antigens in those groups are typed. Medicare pays 86812 only through the Clinical Laboratory Fee Schedule (CLFS), at one nationally set amount across states and localities, without geographic or office-versus-facility adjustment. The 2026 national CLFS amount is $25.81, unchanged since 2020.
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 86812
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 86812. 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 86812 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86812 on the lab fee schedule since 2020
86812 · CLFS 2026 Q4 (current)
$25.81
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.
86812 compared with similar tests
- 86813HLA typingMultiple HLA antigens$58.00
- Use 86812 for a single HLA-A, B, or C antigen; use 86813 when multiple antigens in those groups are typed.
- 86816HLA typingDR/DQ, single antigen$30.17
- 86816 is for HLA-DR or DQ typing, rather than typing an HLA-A, B, or C antigen.
- 86817HLA typingDR/DQ, multiple antigens$106.14
- 86817 covers multiple HLA-DR or DQ antigens; 86812 is for a single HLA-A, B, or C antigen.
86812 billing questions
When should 86812 be chosen instead of 86813?
Use 86812 for typing one selected HLA-A, HLA-B, or HLA-C antigen. Use 86813 when multiple antigens in those groups are typed.
Is HLA-B27 testing an example of 86812?
Yes. HLA-B27 is a single HLA-B antigen; testing may be ordered during evaluation of suspected spondyloarthritis.
Is code selection based on the number of specimens or antigens?
The distinction between 86812 and 86813 is the number of HLA-A, B, or C antigens typed.
What should the record show to support code selection?
The record should identify whether one or multiple HLA-A, B, or C antigens were typed, since that distinguishes 86812 from 86813.
How does Medicare pay 86812?
Medicare pays one national CLFS amount per code, the same across states and localities and without an office or facility adjustment.
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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