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See a sample rate comparisonCPT 86038 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 Disease Test, The Antinuclear Antibody Test Measures The Amount And Pattern Of Antibodies That Work Against The Body (Autoimmune). It Evaluates Connective Tissue Diseases.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $12.09 national lab fee schedule rate (2026) · View Medicare rates for 86038 |
| Medicaid Fee Schedule | $11.94 median of the 8 states in the free preview · View Medicaid rates for 86038 |
National average reimbursement for CPT 86038 by major payers:
$10.51
$8.63
$14.82
$17.43
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CPT 86038
5 of 25 sample ratesHigher to lower in this preview
Carl Crawford
$32.99Published rateMark Shumeyko
Chenango Memorial Hospital Inc
$15.60Published rateMakoto Iwahara
Makoto Iwahara, M.D., P.C.
$7.57Published rateArlene Garcia
Digestive Disease Care, PC
$7.25Published rateHarish Patel
Bronxcare Dr Martin Luther King Jr Health Center
$3.80Published rate
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See a sample payer proposalCPT 86038 vs. Other Immunology Procedures Codes
The CPT 86038 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 86038 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 |
|---|---|---|
| 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. |
| 86038-CPT | Low | Autoimmune Disease Test, The Antinuclear Antibody Test Measures The Amount And Pattern Of Antibodies That Work Against The Body (Autoimmune). It Evaluates Connective Tissue Diseases. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86038. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86038 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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