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 |
National average reimbursement for CPT 86078 by major payers:
$60.38
$34.59
$84.21
$54.12
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 86078 | ||||||
United | 86078 | $24.18 | 1295056273 - JONATHAN MELZER | 592292041 - ST VINCENTS AMBULATORY CARE INC | FL | Otolaryngology Physician (207Y00000X) |
United | 86078 | $23.64 | 1972571727 - MARC FERNANDEZ | 237159870 - (MN) WINDOM AREA HOSPITAL | FL | Surgery Physician (208600000X) |
United | 86078 | $23.47 | 1811351364 - CANDACE GONZALEZ | 331189561 | FL | Surgery Physician (208600000X) |
United | 86078 | $23.78 | 1053610923 - BYRON STAPLETON | 364860252 | FL | Surgery Physician (208600000X) |
United | 86078 | $103.45 | 1154306223 - HARVEY SCHONWALD | 263792403 - PHOEBE PHYSICIAN GROUP INC | FL | Urology Physician (208800000X) |
United | 86078 | $22.04 | 1376040113 - DYLAN THIEL | 650512900 - SMH PHYSICIAN SERVICES INC | FL | Pulmonary Disease Physician (207RP1001X) |
United | 86078 | $31.61 | 1114361730 - NICOLE ROCHET | 582086711 - (GA) DERMATOLOGY SKIN SURGERY CENTER PC | FL | Dermatology Physician (207N00000X) |
United | 86078 | $18.80 | 1275686420 - RIGAUD AND ASSOCIATES PA | 200990057 - (FL) RIGAUD AND ASSOCIATES PA | FL | Urology Physician (208800000X) |
United | 86078 | $23.47 | 1326089244 - IRIANA BELONGIE | 592897287 - (FL) ACADEMIC ALLIANCE IN DERMATOLOGY, INC. | FL | Dermatology Physician (207N00000X) |
United | 86078 | $72.73 | 1033570122 - MOJGAN HOSSEINIPOUR | 542129332 - (FL) VITALMD GROUP HOLDING, LLC | FL | Dermatology Physician (207N00000X) |
United | 86078 | $20.27 | 1497711972 - CHARLES SALZBERG | 831890213 - (FL) DIVANI DERMATOLOGY LLC | FL | Dermatology Physician (207N00000X) |
United | 86078 | $19.00 | 1932889250 - ROGELIO AVELAR | 921919591 - (FL) PRECISION HEALTHCARE SPECIALISTS LLC | FL | Family Nurse Practitioner (363LF0000X) |
United | 86078 | $22.04 | 1932208006 - AMY WITT | 800166709 - (FL) DERROW DERMATOLOGY ASSOCIATES LLC | FL | Dermatology Physician (207N00000X) |
United | 86078 | $23.47 | 1376689232 - SURGICAL ASSOCIATES OF VENICE AND ENGLEWOOD, PA | 591362995 - (FL) SURGICAL ASSOCIATES OF VENICE AND ENGLEWOOD PA | FL | Surgery Physician (208600000X) |
United | 86078 | $19.98 | 1326103763 - PAMELA ROUSSEAU | 650008133 - (FL) SKIN AND CANCER ASSOCIATES, LLP | FL | Dermatology Physician (207N00000X) |
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 Services; Difficult Cross Match And/Or Evaluation Of Irregular Antibody(S), Interpretation And Written Report |
| 86078-CPT | Low | Blood Bank Physician Services; Investigation Of Transfusion Reaction Including Suspicion Of Transmissible Disease, Interpretation And Written Report |
| 86079-CPT | Low | Blood Bank Physician Services; Authorization For Deviation From Standard Blood Banking Procedures (Eg, Use Of Outdated Blood, Transfusion Of Rh Incompatible Units), With Written Report |
| 86161-CPT | Low | Complement Functional Activ Ea Comp |
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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