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See a sample rate comparisonCPT 86053 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.
Test For Devics Disease, Lab Test For Antibodies That Help To Diagnose Neuromyelitis Optica Also Known As Devics Disease. This Is A Rare Condition Where The Immune System Damages The Spinal Cord And The Nerves Of The Eyes.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $37.73 national lab fee schedule rate (2026) · View Medicare rates for 86053 |
| Medicaid Fee Schedule | $34.715 median of the 8 states in the free preview · View Medicaid rates for 86053 |
National average reimbursement for CPT 86053 by major payers:
$22.15
$8.34
$24.04
$70.99
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CPT 86053
5 of 25 sample ratesHigher to lower in this preview
Pelham Medical Center
$37.72Published ratePrisma Health-Upstate, Prisma Health Ob/Gyn Clinic
Prisma Health - Upstate
$33.95Published rateAlexander Hawkins
Neuroscience Group Of Northeast Wisconsin, S.C.
$29.68Published rateEvan Krueger
Neuroscience Group Of Northeast Wisconsin, S.C.
$29.68Published rateBrandon Okeefe Rafaeli
U T Physicians
$5.05Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86053 vs. Other Immunology Procedures Codes
The CPT 86053 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 86053 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 |
|---|---|---|
| 86051-CPT | Low | Test For Devics Disease, Lab Test For Antibodies That Help To Diagnose Neuromyelitis Optica Also Known As Devics Disease. This Is A Rare Condition Where The Immune System Damages The Spinal Cord And The Nerves Of The Eyes. |
| 86052-CPT | Low | Test For Devics Disease, Lab Test For Antibodies That Help To Diagnose Neuromyelitis Optica Also Known As Devics Disease. This Is A Rare Condition Where The Immune System Damages The Spinal Cord And The Nerves Of The Eyes. |
| 86053-CPT | Low | Test For Devics Disease, Lab Test For Antibodies That Help To Diagnose Neuromyelitis Optica Also Known As Devics Disease. This Is A Rare Condition Where The Immune System Damages The Spinal Cord And The Nerves Of The Eyes. |
| 86235-CPT | Low | Autoimmune Disease Test, This Test Detects Antibodies To Cell Components And Proteins. The Test Is Used To Diagnose And Assess Progression Of 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 86053. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86053 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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