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 86258 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 91 - Repeat Lab Test |
| Complexity Level | Low |
| Medicare Fee Schedule | $12.05 national lab fee schedule rate (2026) · View Medicare rates for 86258 |
| Medicaid Fee Schedule | $11.64 median of the 8 states in the free preview · View Medicaid rates for 86258 |
National average reimbursement for CPT 86258 by major payers:
$10.04
$7.09
$12.14
$43.57
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 86258.
CPT 86258
5 of 25 sample ratesHigher to lower in this preview
Lauran Brice
Neuroscience Group Of Northeast Wisconsin, S.C.
$28.39Published rateKristen Musser
Neuroscience Group Of Northeast Wisconsin, S.C.
$28.39Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$11.52Published ratePrisma Health-Upstate, Prisma Health Center For Pediatric Med
Prisma Health - Upstate
$10.85Published rateNorthwest Texas Surgical Hospital, LLC, Northwest Texas Surgery Center
Northwest Texas Surgical Hospital LLC
$4.84Published 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 86258 vs. Other Immunology Procedures Codes
The CPT 86258 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 86258 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 |
|---|---|---|
| 86140-CPT | Low | Blood Test For Inflammation, This Test Measures A Protein That Is An Indicator Of Inflammation Related To Bacteria And Tissue Damage. |
| 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. |
| 86256-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. |
| 86258-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 86258. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86258 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 86258) and we'll show you how you compare in 15 minutes or less.