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See a sample rate comparisonCPT 86021 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.
Autoimmune Blood Test, Autoantibody Tests Detect Antibodies To White Blood Cells (Leukocytes) Or Platelets. Leukocyte Antibodies Cause Reactions To Blood Transfusion And Pregnancy Complications. Platelet Antibodies Cause Bleeding Or Bruising And Low Platelet Counts.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $15.05 national lab fee schedule rate (2026) · View Medicare rates for 86021 |
| Medicaid Fee Schedule | $13.845 median of the 8 states in the free preview · View Medicaid rates for 86021 |
National average reimbursement for CPT 86021 by major payers:
$13.01
$10.36
$17.71
$22.74
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CPT 86021
5 of 25 sample ratesHigher to lower in this preview
Vhs Harlingen Hospital Company LLC, Valley Baptist Medical Center
$60.00Published rateChildress County Hospital District, Childress Regional Medical Center
$18.05Published rateSt Francis Medical Center, Inc
St Francis Medical Center Inc
$15.05Published rateAsya Segalene
Allergy & Asthma Of Dupage, S.C.
$9.45Published rateAscension Seton, Ascension Seton Medical Center Austin
Ascension Seton
$5.71Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86021 vs. Other Immunology Procedures Codes
The CPT 86021 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 86021 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. |
| 86021-CPT | Low | Autoimmune Blood Test, Autoantibody Tests Detect Antibodies To White Blood Cells (Leukocytes) Or Platelets. Leukocyte Antibodies Cause Reactions To Blood Transfusion And Pregnancy Complications. Platelet Antibodies Cause Bleeding Or Bruising And Low Platelet Counts. |
| 86022-CPT | Low | Autoimmune Blood Test, Autoantibody Tests Detect Antibodies To White Blood Cells (Leukocytes) Or Platelets. Leukocyte Antibodies Cause Reactions To Blood Transfusion And Pregnancy Complications. Platelet Antibodies Cause Bleeding Or Bruising And Low Platelet Counts. |
| 86023-CPT | Low | Autoimmune Blood Test, Autoantibody Tests Detect Antibodies To White Blood Cells (Leukocytes) Or Platelets. Leukocyte Antibodies Cause Reactions To Blood Transfusion And Pregnancy Complications. Platelet Antibodies Cause Bleeding Or Bruising And Low Platelet Counts. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86021. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86021 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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