Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 86235 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 Detects Antibodies To Cell Components And Proteins. The Test Is Used To Diagnose And Assess Progression Of Connective Tissue Diseases.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 59 - Distinct Procedural Service 91 - Repeat Lab Test |
| Complexity Level | Low |
| Medicare Fee Schedule | $17.93 national lab fee schedule rate (2026) · View Medicare rates for 86235 |
| Medicaid Fee Schedule | $17.705 median of the 8 states in the free preview · View Medicaid rates for 86235 |
National average reimbursement for CPT 86235 by major payers:
$15.48
$12.63
$21.08
$25.96
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 86235.
CPT 86235
5 of 25 sample ratesHigher to lower in this preview
Daniel Dahle
Neuroscience Group Of Northeast Wisconsin, S.C.
$44.16Published rateBillie Sturgeon
Neuroscience Group Of Northeast Wisconsin, S.C.
$44.16Published rateLeanne Dada
$10.78Published rateMohammed Bari
Hillcroft Medical Clinic Association
$10.43Published rateDallas Arthritis Center,PA
Dallas Arthritis Centerpa
$7.53Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 86235 vs. Other Immunology Procedures Codes
The CPT 86235 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 86235 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. |
| 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. |
| 86255-CPT | Low | Test For Autoimmune Condition, This Test Identifies Antibodies That Are Involved In Noninfectious Diseases. The Test Aids Diagnosis Especially Of Those Diseases Related To Autoimmune Processes. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86235. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86235 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 86235) and we'll show you how you compare in 15 minutes or less.