Hepatitis C Screening Cost and Medicare Coverage (CPT 86803)
Also called: hep C test · HCV antibody test · anti-HCV — all the same test, CPT 86803.
National policy — the same Medicare rules apply in every state what's this?
This test is governed by a National Coverage Determination (NCD) — a rule issued by CMS, the federal agency that runs Medicare. It spells out which diagnoses justify the test and any frequency limits, it applies identically in all 50 states, and no regional contractor can override it. What you read on this page is the rule everywhere.
- Does Medicare cover it?
- Yes — with frequency limits
- You pay if covered
- $0 — no deductible, no coinsurance
- Medicare pays the lab
- $14.27
- Information verified
- 2026-09-17
Buy it yourself — what you'd really pay
| Where | Test price | Fee | Total |
|---|---|---|---|
| Jason Health jasonhealth.com · antibody with automatic follow-up RNA test if positive | $25 | $18 one fee per order — covers every test on it | $43 |
| Ulta Lab Tests ultalabtests.com · antibody with automatic follow-up RNA test if positive Partner link — we earn a commission if you order. No extra cost to you. | $35.95 | $12.95 draw fee — one per order, covers every test on it | $48.90 |
| Quest questhealth.com | $62 | $6 physician service fee | $68 |
| Labcorp ondemand.labcorp.com | $69 | — | $69 |
Disclosure: the Ulta Lab Tests link above is a partner link. If you order through it, ClaraCover earns a commission. It costs you nothing extra, and it never changes what we tell you about Medicare coverage.
The short answer
Yes — free, if you fit one of three doors, and most Medicare patients fit the first one. Medicare covers hepatitis C screening at $0 when your primary care provider orders it and you either were born between 1945 and 1965 (that’s most of today’s Medicare population — one screening in your lifetime), had a blood transfusion before 1992 or past injection drug use (once in your lifetime), or have ongoing risk (once every year). The rules are national — the same in every state.
When Medicare DOES cover it
- Born 1945–1965: one free screening in your lifetime, no other risk factors needed. If you’ve never had one, you’re owed it.
- Past risk — a blood transfusion before 1992, or prior injection drug use: once in your lifetime.
- Ongoing risk — continued injection drug use since a previous negative test: once every 12 months.
- One paperwork detail from the benefit: the order needs to come from your primary care provider in a primary care setting.
And separately from screening: if there’s a genuine medical reason — known exposure, abnormal liver tests, symptoms — hepatitis C testing is diagnostic and follows ordinary medical-necessity rules at any time.
When Medicare does NOT cover it
- Repeat screening beyond your door’s frequency — a second lifetime screen with no new risk, or an annual test without ongoing risk.
- A screening ordered outside the primary-care pathway can also stumble on the benefit’s technicalities — worth asking your doctor’s office to order it as the preventive service it is.
What you pay if it IS covered: $0
The screening benefit waives everything — no deductible, no coinsurance. Medicare pays the lab $14.27, and you owe zero.
What it costs to buy yourself
No doctor’s visit, no eligibility questions: the hepatitis C antibody test sells for $25 at Jason Health (jasonhealth.com — add their flat $18 lab-collection fee per order; their version automatically runs the confirmatory RNA test if the antibody is positive), $62 at Quest’s consumer site (questhealth.com, plus a $6 physician fee), and $69 at Labcorp OnDemand.
What counts as a “normal” hepatitis C test result
There is no range for this one. A hepatitis C antibody screening test does not produce a number to compare against a range. The result is negative (non-reactive) or positive (reactive).
A positive screening result is not a diagnosis. It means the test found something that needs following up with a further test, and your doctor will explain what that next step is.
(Where lab ranges and “optimal” ranges come from, and who decides.)
This page can tell you where those numbers came from. It cannot tell you what yours means — that reading belongs to your doctor, alongside your history and your other results.
Quick questions people ask
Why would a doctor order a hep C test? Two big reasons. First, public-health guidance now recommends every adult get screened at least once — hepatitis C often causes no symptoms for decades while quietly damaging the liver, and today’s treatments cure most cases. Second, diagnostically: unexplained abnormal liver enzymes (such as a high GGT), known exposure, or symptoms of liver trouble. If you were born 1945–1965, being offered the test is routine, not a suspicion. When liver tests are already abnormal, doctors often order the acute hepatitis panel instead, which checks hepatitis A, B, and C together under a different Medicare rule.
Where can you get tested for hepatitis C? Any lab, with your doctor’s order — free under the screening benefit if you qualify — or directly from the consumer lab sites above without any order. Many health departments also offer low-cost testing.
What does a “nonreactive” hep C result mean? Nonreactive = negative: no hepatitis C antibodies found. A “reactive” result means antibodies are present — which shows past exposure, not necessarily current infection — and the next step is an RNA test to check for active virus. Your doctor walks you through that path.
Do you have to fast for a hepatitis C test? No. Fasting isn’t required. If it’s drawn at the same visit as a test that does need fasting, you fast for the visit. Our fasting guide lists which tests need it.
Sources and data dates
Screening rules: medicare.gov, “Hepatitis C virus infection screenings.” Medicare payment amount: CMS Clinical Laboratory Fee Schedule, 2026 Q3 file (national rate). Consumer prices checked September 2026. Information current as of the date shown above; coverage is always determined by Medicare when your claim is processed.
ClaraCover provides information, not medical, billing, or insurance advice. Talk to your doctor about what tests you need.
Covered diagnoses for CPT 86803
There is no national diagnosis list for CPT 86803. Coverage follows the general "reasonable and necessary" standard and any local coverage determination your Medicare contractor has written, as this page describes; the diagnosis on the order still has to support the test.
Billing office? The full list, a batch check, and no daily limit are what we are building for you: tell us you want it. For why lab tests are the one place Medicare gives a straight answer, see what "reasonable and necessary" means.