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See a sample rate comparisonCPT 84206 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Digestive Enzyme Test, The Test Measures Proinsulin Made By The Pancreas To Help Digest Sugars. It Is Involved In The Conversion Of Glucose.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Chemistry Procedures |
| Common Place of Service | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | None 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 84206 |
| Medicaid Fee Schedule | View Medicaid rates for 84206 |
National average reimbursement for CPT 84206 by major payers:
$20.99
$15.64
$26.75
$38.96
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CPT 84206
5 of 25 sample ratesHigher to lower in this preview
All Ways Homecare Inc
$60.00Published rateEmerus Bhs Sa Thousand Oaks LLC
$26.69Published ratePrisma Health-Upstate, Prisma Health Int Med/Subspec Clinic
Prisma Health - Upstate
$24.02Published rateChristopher Raio
St Joseph Hospital
$14.41Published rateMolly Mcintosh
Baycare Medical Group Inc
$7.71Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 84206 vs. Other Chemistry Procedures Codes
The CPT 84206 code is part of the Pathology and Laboratory Procedures services used for Chemistry Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 84206 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 84206-CPT | Low | Digestive Enzyme Test, The Test Measures Proinsulin Made By The Pancreas To Help Digest Sugars. It Is Involved In The Conversion Of Glucose. |
| 84233-CPT | Low | Breast Cancer Therapy Test, The Test Checks How A Sample Of Tissue (Biopsy) Responds To Chemotherapy Or Hormone Therapy That Has Been Proposed To Treat Breast Cancer. |
| 84402-CPT | Low | Testosterone Hormone Test, Testosterone Helps Balance Male-Female Secondary Sex Characteristics Like Body Hair. Results Help Evaluate Pituitary Gland And Sex Gland Conditions. |
| 84410-CPT | Low | Testosterone; Bioavailable Direct Measurement (Eg Differential Precipitation). (Reinstated 01/01/2017). Thallium Blood Or Urine (Del 03/31/2003) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 84206. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 84206 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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