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See a sample rate comparisonCPT 86231 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.
Test For Proteins In Gluten, Lab Test For Antibodies That May Be Elevated In Persons With Celiac Disease A Digestive Condition Caused By An Immune Reaction To Gluten.
| 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 | $12.09 national lab fee schedule rate (2026) · View Medicare rates for 86231 |
| Medicaid Fee Schedule | $11.125 median of the 8 states in the free preview · View Medicaid rates for 86231 |
National average reimbursement for CPT 86231 by major payers:
$10.34
$7.29
$12.36
$43.71
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CPT 86231
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$26.60Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$12.09Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$8.92Published rateNevada Eye Care Professionals Little & Stein, Ltd.
Nevada Eye Care Professionals
$5.08Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$4.84Published rate
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See a sample payer proposalCPT 86231 vs. Other Immunology Procedures Codes
The CPT 86231 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 86231 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. |
| 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. |
| 86231-CPT | Low | Test For Proteins In Gluten, Lab Test For Antibodies That May Be Elevated In Persons With Celiac Disease A Digestive Condition Caused By An Immune Reaction To Gluten. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86231. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86231 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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