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See a sample rate comparisonCPT 86226 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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital |
| Common Modifiers | 26 - Professional component TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | $12.11 national lab fee schedule rate (2026) · View Medicare rates for 86226 |
| Medicaid Fee Schedule | $11.96 median of the 8 states in the free preview · View Medicaid rates for 86226 |
National average reimbursement for CPT 86226 by major payers:
$10.76
$12.90
$14.28
$17.88
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CPT 86226
5 of 25 sample ratesHigher to lower in this preview
Armine Tumyan
$23.25Published rateAtul Singhal
Southwest Arthritis Research Group PA
$7.26Published rateRheumatology Associates Of Greater Houston PLLC
$5.09Published rateDallas Arthritis And Autoimmune Disease Center PLLC, Arthritis & Autoimmunity Clinic
Dallas Arthritis And Autoimmune Disease Center PLLC
$5.09Published rateMegha Patel-Banker
Arthritis And Rheumatology Institute PLLC
$5.09Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86226 vs. Other Immunology Procedures Codes
The CPT 86226 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 86226 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 |
|---|---|---|
| 86146-CPT | Low | Test For Blood Condition, The Test Looks For Antibodies That Are Present In Aps (Antiphospholipid) Syndrome. Aps Causes Abnormal Blood Clotting With A Low Platelet Count And Greatly Increases The Likelihood Of Miscarriage. |
| 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. |
| 86226-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. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86226. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86226 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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