CPT 86078 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 | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None GC - Service performed by resident under supervision 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86078 |
National average reimbursement for CPT 86078 by major payers:
$60.38
$34.59
$84.21
$51.37
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 86078 | $16.90 | 1003973645 - RUSSELL NOVAK | 650189869 - SARASOTA SURGICAL SPECIALISTS, PA | FL | Surgery Physician (208600000X) |
United | 86078 | $23.21 | 1104182708 - DAVID ALVAREZ | 593598056 - TALLAHASSEE ORTHOPEDIC CLINIC III | FL | Orthopaedic Hand Surgery Physician (207XS0106X) |
United | 86078 | $72.73 | 1033570122 - MOJGAN HOSSEINIPOUR | 542129332 - (FL) VITALMD GROUP HOLDING, LLC | FL | Dermatology Physician (207N00000X) |
United | 86078 | $33.75 | 1417048331 - KENNETH SON | 273818647 | FL | Urology Physician (208800000X) |
United | 86078 | $62.77 | 1972571727 - MARC FERNANDEZ | 271081647 - TRIANGLE PHYSICIAN NETWORK LLC | FL | Surgery Physician (208600000X) |
United | 86078 | $23.64 | 1598114969 - ADAM BULTER | 463778226 | FL | Surgery Physician (208600000X) |
United | 86078 | $20.47 | 1285193193 - MICHAEL FOSS | 591773262 - MCR HEALTH INC | FL | Dermatology Physician (207N00000X) |
United | 86078 | $103.45 | 1154306223 - HARVEY SCHONWALD | 263792403 - PHOEBE PHYSICIAN GROUP INC | FL | Urology Physician (208800000X) |
United | 86078 | $23.78 | 1477761104 - VICTOR COBA | 237313346 - UNIVERSITY MEDICAL SERVICE ASSOCIATION INC | FL | Pulmonary Disease Physician (207RP1001X) |
United | 86078 | $33.77 | 1518921303 - DEBORAH LONGWILL | 650682570 - (FL) DEBORAH LONGWILL DO PA | FL | Dermatology Physician (207N00000X) |
United | 86078 | $23.47 | 1740208404 - AHMAD JALLOUL | 208440392 - (FL) PULMONARY CRITICAL CARE SLEEP SPECIALISTS OF LAKE COUNTY PA | FL | Pulmonary Disease Physician (207RP1001X) |
United | 86078 | $56.52 | 1104808054 - JACK HAJ OBEID | 462354804 - FLORIDA HOSPITAL HEALTHCARE PARTNERS INC | FL | Pulmonary Disease Physician (207RP1001X) |
United | 86078 | $20.27 | 1386607836 - WADDAH ALLAF | 650939115 - WADDAH ALLAF, M.D., P.A. | FL | Pulmonary Disease Physician (207RP1001X) |
United | 86078 | $23.47 | 1528492287 - GREATER TAMPA BAY PHYSICIAN SPECIALISTS, LLC | 901005885 - (FL) GREATER TAMPA BAY PHYSICIAN SPECIALISTS LLC | FL | Surgery Physician (208600000X) |
United | 86078 | $23.61 | 1770010597 - NICHOLAS GEORGALAS | 593366100 - NORTH FLORIDA SURGEONS, P.A. | FL | Surgery Physician (208600000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 86078 vs. Other Immunology Procedures Codes
The CPT 86078 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 86078 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 |
|---|---|---|
| 86077-CPT | Low | Blood Bank Physician Consult, Physician Consultation That Includes An Interpretation And Written Report For Use Of Blood. A Consult Is Requested When There Are Difficulties In Matching The Blood Type Or If The Situation Adds An Unusual Complexity (Such As A Reaction To A Transfusion). |
| 86078-CPT | Low | Blood Bank Physician Consult, Physician Consultation That Includes An Interpretation And Written Report For Use Of Blood. A Consult Is Requested When There Are Difficulties In Matching The Blood Type Or If The Situation Adds An Unusual Complexity (Such As A Reaction To A Transfusion). |
| 86079-CPT | Low | Blood Bank Physician Consult, Physician Consultation That Includes An Interpretation And Written Report For Use Of Blood. A Consult Is Requested When There Are Difficulties In Matching The Blood Type Or If The Situation Adds An Unusual Complexity (Such As A Reaction To A Transfusion). |
| 86161-CPT | Low | Immune Function Blood Test, The Complement System Is A Group Of Proteins Related To Inflammation That Work With The Immune System. The Blood Complement Test Helps Monitor Progression Of Autoimmune Disease Inflammation And Certain Infections. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86078. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86078 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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