CPT 86160 Medicare Lab Fee Schedule 2026
Medicare's 2026 national Clinical Laboratory Fee Schedule payment for CPT 86160 is $12.00, unchanged from 2025.
- National
- $12.00
- vs. 2025
- No change
- Commercial national avg.
- $12.99
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86160 national rate by year
Each row is the latest CMS file published that year. Change is against the year before.
| CMS file | National payment | Change |
|---|---|---|
| January 2026 | $12.00 | No change |
| January 2025 | $12.00 | No change |
| January 2024 | $12.00 | No change |
| January 2023 | $12.00 | No change |
| January 2022 | $12.00 | - |
Since 2018 the Clinical Laboratory Fee Schedule pays one national amount per code, set from private-payer rates that laboratories report to CMS, so this figure is the same in every locality.
86160: Medicare vs. commercial national average
The commercial national average for 86160, the mean of what BCBS, UnitedHealthcare, Aetna and Cigna publish nationwide, is $12.99, 108% of Medicare's $12.00.
- BCBS $10.54
- UnitedHealthcare $9.33
- Aetna $14.45
- Cigna $17.63
A national average, not a local rate: each payer's figure averages the unmodified, in-network professional rates it publishes for 86160 across the country in its transparency files. Contracted rates vary widely by market, provider and plan. Medicare's figure is its national Clinical Laboratory Fee Schedule payment.
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Methodology
Rates come from the CMS Clinical Laboratory Fee Schedule (CLFS), published quarterly. Each HCPCS payment amount reflects the national CLFS payment for outpatient laboratory services.
View CMS Clinical Laboratory Fee Schedule