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See a sample rate comparisonCPT 86001 Fee Schedule
Last Verified: October 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.
Allergy Blood Test, This Blood Test Identifies A Substance Triggering An Allergy (Allergen). It Measures The Amount Of Immunoglobulin Directed Against A Specific Allergen.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 91 - Repeat Lab Test 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $7.82 national lab fee schedule rate (2026) · View Medicare rates for 86001 |
| Medicaid Fee Schedule | $7.54 median of the 8 states in the free preview · View Medicaid rates for 86001 |
National average reimbursement for CPT 86001 by major payers:
$6.19
$4.67
$7.59
$10.98
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CPT 86001
5 of 25 sample ratesHigher to lower in this preview
Titus County Hospital District, Titus Regional Medical Center
$9.38Published rateOpelousas General Hospital Authority
$7.82Published rateLallie Kemp Medical Ctr, Lallie Kemp Regional Medical Center
$7.03Published rateSt Helena Parish Hospital, St Helena Parish Hospital
St Helena Parish Hospital
$4.48Published rateVictory Medical Center Landmark, Lp
$2.81Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86001 vs. Other Immunology Procedures Codes
The CPT 86001 code is part of the Pathology and Laboratory Procedures services used for Immunology 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 86001 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 |
|---|---|---|
| 86000-CPT | Low | Immune Response To Infection, Immune Response Is Measured By Evaluating The Amount Of Antigen-To-Antibody Clumping In A Blood Sample. This Test Measures Immune Response To An Infection That Causes A Fever. |
| 86001-CPT | Low | Allergy Blood Test, This Blood Test Identifies A Substance Triggering An Allergy (Allergen). It Measures The Amount Of Immunoglobulin Directed Against A Specific Allergen. |
| 86003-CPT | Low | Allergy Blood Test, This Blood Test Identifies A Substance Triggering An Allergy (Allergen). It Measures The Amount Of Immunoglobulin Directed Against A Specific Allergen. |
| 86005-CPT | Low | Allergy Blood Test, This Blood Test Identifies A Substance Triggering An Allergy (Allergen). It Measures The Amount Of Immunoglobulin Directed Against A Specific Allergen. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86001. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86001 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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