CPT 86036 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 90 - Reference Laboratory 91 - Repeat Lab Test |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86036 |
| Medicaid Fee Schedule | View Medicaid rates for 86036 |
National average reimbursement for CPT 86036 by major payers:
$10.32
$7.25
$12.63
$43.70
CPT 86036 vs. Other Immunology Procedures Codes
The CPT 86036 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 86036 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 |
|---|---|---|
| 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. |
| 86036-CPT | Low | Screening For Anca, Screening For Antineutrophil Cytoplasmic Antibodies To Help Detect And Diagnose Certain Forms Of Autoimmune Vasculitis. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86036. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86036 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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