CPT 86162 Fee Schedule

Medicare rates as of January 2026

CPT 86162 is classified under Pathology and Laboratory Procedures, in the Immunology Procedures subgroup.

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.

Key Fact	Detail
Service Type	Pathology and Laboratory Procedures Immunology Procedures
Common Place of Service	81 - Independent Laboratory 11 - Office
Common Modifiers	90 - Reference Laboratory 26 - Professional component
Complexity Level	Low
Medicare Fee Schedule	$20.32 national lab fee schedule rate (2026) · View Medicare rates for 86162
Medicaid Fee Schedule	$20.065 median of the 8 states in the free preview · View Medicaid rates for 86162

National average reimbursement for CPT 86162 by major payers:

$18.19

BCBS / Anthem

$14.51

UnitedHealthcare

$23.30

Aetna

$29.87

Cigna

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CPT 86162

5 of 25 sample ratesHigher to lower in this preview

Hcn Ep Horizon City, LLC, The Hospitals Of Providence Horizon City Campus
Hcn Ep Horizon City LLC
TXGeneral Acute Care HospitalNPI 1003344334Tax ID 81-3935393
$60.00Published rate
Hcn Ep Horizon City, LLC, The Hospitals Of Providence Northeast Campus
Hcn Ep Horizon City LLC
TXGeneral Acute Care HospitalNPI 1861994808Tax ID 81-3935393
$20.31Published rate
Athens Hospital, LLC
TXGeneral Acute Care HospitalNPI 1417465824Tax ID 82-3934511
$20.31Published rate
Christopher Raio
Mercy Medical Center
NYEmergency Medicine PhysicianNPI 1255478004Tax ID 11-1635088
$12.19Published rate
St. Davids Healthcare Partnership, L.P., LLP, Heart Hospital Of Austin
Lone Star Circle Of Care
TXGeneral Acute Care HospitalNPI 1720033947Tax ID 74-3001674
$8.52Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 86162 vs. Other Immunology Procedures Codes

The table lists codes related to 86162. Select one to see its fee schedule.

Code	Complexity	Description
86160-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.
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.
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.
86171-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 86162. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 86162 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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