CPT code 86816: HLA typing, DR/DQ, single antigen2026 Medicare lab fee · Clinical Laboratory Fee Schedule
HLA DR/DQ single-antigen analysis is reported for immunologic evaluation of autoimmune disease when this specific HLA typing service is performed.
Medicare pays $30.17 for 86816 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
$30.17
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 86816 covers
Code 86816 identifies HLA typing in the DR/DQ groups at the single-antigen level, used in immunologic analysis for autoimmune disease. It distinguishes this service from DR/DQ typing that covers multiple antigens (86817) and from HLA typing directed to A/B/C groups (86812 or 86813). HLA typing reports antigen findings; it is distinct from HLA antibody testing, which assesses antibodies rather than typing the DR/DQ antigen. The code is specific to the DR/DQ single-antigen service, not a general HLA test.
Report 86816 for the single-antigen DR/DQ typing service performed; it is not the code for multiple-antigen DR/DQ typing. Medicare pays 86816 only through the CLFS. The 2026 national CLFS amount is $30.17 and has remained unchanged since 2020. One national amount applies in every state and locality, without geographic adjustment or an office/facility difference.
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 86816
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 86816. 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 86816 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86816 on the lab fee schedule since 2020
86816 · CLFS 2026 Q4 (current)
$30.17
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.
86816 compared with similar tests
- 86817HLA typingDR/DQ, multiple antigens$106.14
- Both address DR/DQ typing. Choose 86816 for the single-antigen service and 86817 for multiple-antigen typing.
- 86812HLA typingSingle HLA-A, B, or C antigen$25.81
- 86812 addresses single-antigen HLA typing in the A/B/C groups; 86816 addresses DR/DQ.
- 86813HLA typingMultiple HLA antigens$58.00
- 86813 is multiple-antigen HLA typing for A/B/C groups. 86816 is single-antigen typing for DR/DQ.
- 86828HLA antibodiesBoth HLA classes$64.19
- 86828 is qualitative HLA class I and II antibody testing. 86816 is DR/DQ antigen typing at the single-antigen level.
86816 billing questions
How does 86816 differ from 86817?
86816 is for single-antigen DR/DQ typing. 86817 is for DR/DQ typing that covers multiple antigens.
When is 86816 preferable to HLA A/B/C typing?
Use 86816 for DR/DQ typing. Codes 86812 and 86813 address HLA typing in the A/B/C groups.
Does 86816 report HLA antibody testing?
No. It reports DR/DQ typing at the single-antigen level, rather than testing for HLA antibodies.
Does 86816 cover multiple DR/DQ antigens?
No. It identifies the single-antigen DR/DQ service; 86817 is for multiple-antigen DR/DQ typing.
How does Medicare pay 86816?
Medicare pays 86816 through the CLFS only. One national amount applies across localities, without geographic or office/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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