CPT 86215 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 | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86215 |
| Medicaid Fee Schedule | View Medicaid rates for 86215 |
National average reimbursement for CPT 86215 by major payers:
$11.88
$9.49
$15.72
$19.39
CPT 86215 vs. Other Immunology Procedures Codes
The CPT 86215 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 86215 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 |
|---|---|---|
| 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. |
| 86215-CPT | Low | Autoimmune Disease Test, This Test Is Performed When Autoimmune Disease Involving Connective Tissue Is Suspected. The Test Identifies When An Immune System Creates Dna Antibodies To Destroy The Bodys Own Tissue. |
| 86225-CPT | Low | Autoimmune Disease Test, This Test Is Performed When Autoimmune Disease Involving Connective Tissue Is Suspected. The Test Identifies When An Immune System Creates Dna Antibodies To Destroy The Bodys Own Tissue. |
| 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 86215. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86215 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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