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See a sample rate comparisonCPT 86157 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.
Blood Clumping Test, This Test Evaluates Blood At A Low Temperature. A Type Of Immune Cell Called A Cold Agglutinin Causes Red Blood Cells To Clump Together. If Many Are Present In A Sample This Can Point Toward A Diagnosis.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $8.06 national lab fee schedule rate (2026) · View Medicare rates for 86157 |
| Medicaid Fee Schedule | $7.68 median of the 8 states in the free preview · View Medicaid rates for 86157 |
National average reimbursement for CPT 86157 by major payers:
$7.13
$5.67
$9.15
$12.19
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CPT 86157
5 of 25 sample ratesHigher to lower in this preview
All Ways Homecare Inc
$60.00Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$9.58Published rateOconee Medical Center
Prisma Health - Upstate
$7.25Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$4.84Published rateBrandon Okeefe Rafaeli
U T Physicians
$3.39Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86157 vs. Other Immunology Procedures Codes
The CPT 86157 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 86157 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 |
|---|---|---|
| 86152-CPT | Moderate | Count Of Cells In Fluid Sample, A Lab Test That Counts The Number Of A Specific Type Of Cells In A Sample Of Fluid. For Example The Test May Be Used To Count Tumor Cells In A Blood Sample. |
| 86156-CPT | Low | Blood Clumping Test, This Test Evaluates Blood At A Low Temperature. A Type Of Immune Cell Called A Cold Agglutinin Causes Red Blood Cells To Clump Together. If Many Are Present In A Sample This Can Point Toward A Diagnosis. |
| 86157-CPT | Low | Blood Clumping Test, This Test Evaluates Blood At A Low Temperature. A Type Of Immune Cell Called A Cold Agglutinin Causes Red Blood Cells To Clump Together. If Many Are Present In A Sample This Can Point Toward A Diagnosis. |
| 86162-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 86157. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86157 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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