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See a sample rate comparisonCPT 86042 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.
Myasthenia Gravis Blood Test, Blood Test To Help Diagnose Myasthenia Gravis A Condition Caused By A Breakdown In Communication Between Nerves And Muscles.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Complexity Level | Low |
| Medicare Fee Schedule | $18.40 national lab fee schedule rate (2026) · View Medicare rates for 86042 |
| Medicaid Fee Schedule | $16.93 median of the 8 states in the free preview · View Medicaid rates for 86042 |
National average reimbursement for CPT 86042 by major payers:
$14.35
$18.62
$24.23
$46.46
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CPT 86042
5 of 25 sample ratesHigher to lower in this preview
Lisa Truttschel
The Neuroscience Group Of Northeast Wisconsin Sc
$45.31Published rateUniversity Health Services,Inc, University Hospital
University Health Services Inc
$16.55Published rateChildrens National Medical Center
Childrens Hospital
$11.04Published rateProgressive Medical Center Sc
Progressive Medical Center, S.C.
$10.11Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$7.36Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86042 vs. Other Immunology Procedures Codes
The CPT 86042 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 86042 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 |
|---|---|---|
| 86042-CPT | Low | Myasthenia Gravis Blood Test, Blood Test To Help Diagnose Myasthenia Gravis A Condition Caused By A Breakdown In Communication Between Nerves And Muscles. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86042. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86042 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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