CPT 86001 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Pathology and Laboratory Procedures • Immunology Procedures |
| Common Place of Service | • 81 - Independent Laboratory • 11 - Office |
| Common Modifiers | • None • 91 - Repeat Lab Test • 90 - Reference Laboratory |
| Complexity Level | Low |
National average reimbursement for CPT 86001 by major payers:
$6.19
$4.67
$7.59
$11.32
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 86001 | ||||||
United | 86001 | $7.30 | 1558311936 - TEMPLE VAMC | 742791419 | TX | General Acute Care Hospital (282N00000X) |
United | 86001 | $7.82 | 1467129700 - VHS SAN ANTONIO PARTNERS, LLC, NORTHEAST BAPTIST HOSPITAL | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 86001 | $7.82 | 1932204427 - NMC OPERATING COMPANY LLC, THE SPINE HOSPITAL OF LOUISIANA | 270059959 - (LA) NMC OPERATING COMPANY, LLC | LA | General Acute Care Hospital (282N00000X) |
United | 86001 | $7.82 | 1538522412 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE TRANSMOUNTAIN CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 86001 | $7.82 | 1730697350 - JACKSONVILLE HOSPITAL LLC, UTHEALTH EAST TEXAS JACKSONVILLE HOSPITAL | 824037220 | TX | General Acute Care Hospital (282N00000X) |
United | 86001 | $6.57 | 1245878990 - HUNTSVILLE COMMUNITY HOSPITAL, INC. | 843654542 - (TX) HUNTSVILLE COMMUNITY HOSPITAL INC | TX | General Acute Care Hospital (282N00000X) |
United | 86001 | $7.82 | 1528027786 - METHODIST HOSPITALS OF DALLAS, METHODIST DALLAS MEDICAL CENTER | 750800661 - METHODIST HOSPITALS OF DALLAS | TX | General Acute Care Hospital (282N00000X) |
United | 86001 | $11.72 | 1639263189 - LASALLE PARISH HOSPITAL SERVICE DIST NO1, HARDTNER MEDICAL CENTER | 720652984 - (LA) HARDTNER MEDICAL CENTER | LA | Critical Access Hospital (282NC0060X) |
United | 86001 | $7.82 | 1891873337 - CLHG, MINDEN MEDICAL CENTER | 824625698 | LA | Rural Acute Care Hospital (282NR1301X) |
United | 86001 | $7.03 | 1467496802 - ST FRANCIS HOSPITAL, INC., ST. FRANCIS EASTSIDE | 582504530 - (SC) ST FRANCIS HOSPITAL INC | SC | General Acute Care Hospital (282N00000X) |
United | 86001 | $7.82 | 1609860360 - OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL, ASSUMPTION COMMUNITY HOSPITAL | 721495500 - (LA) OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL INC | LA | Rural Acute Care Hospital (282NR1301X) |
United | 86001 | $7.82 | 1447230388 - OPELOUSAS GENERAL HOSPITAL AUTHORITY | 720708111 | LA | General Acute Care Hospital (282N00000X) |
United | 86001 | $7.03 | 1942294939 - ST JOSEPH REGIONAL HEALTH CENTER, ST JOSEPH AMBULATORY SURGERY | 741282696 - ST JOSEPH REGIONAL HEALTH CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 86001 | $7.03 | 1568663920 - PROGRESSIVE ACUTE CARE AVOYELLES, LLC, AVOYELLES HOSPITAL | 813465468 | LA | General Acute Care Hospital (282N00000X) |
United | 86001 | $2.99 | 1093783391 - CHRISTUS SPOHN HEALTH SYSTEM CORPORATION, CHRISTUS SPOHN HOSPITAL KLEBERG | 760422435 - C H WILKINSON PHYSICIAN NETWORK | TX | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 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 | Agglutinins, Febrile (Eg, Brucella, Francisella, Murine Typhus, Q Fever, Rocky Mountain Spotted Fever, Scrub Typhus), Each Antigen |
| 86001-CPT | Low | Allergen Specific Igg Quantitative Or Semiquantitative, Each Allergen |
| 86003-CPT | Low | Allergen Specific Ige; Quantitative Or Semiquantitative Crude Allergen Extract Each (Desc Revised 1/1/2018) |
| 86005-CPT | Low | Allergen Specific Ige; Qualitative Multiallergen Screen (Eg Disk Sponge Card) (Desc Revised 1/1/2018) |
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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