CPT 86277 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 GA - Required ABN issued and on file |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86277 |
| Medicaid Fee Schedule | View Medicaid rates for 86277 |
National average reimbursement for CPT 86277 by major payers:
$14.37
$11.44
$17.84
$22.90
CPT 86277 vs. Other Immunology Procedures Codes
The CPT 86277 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 86277 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 |
|---|---|---|
| 86277-CPT | Low | Human Growth Hormone Test, The Human Growth Hormone (Hgh) Antibody Test Is Used Primarily To Detect Use Of Hgh In Athletes To Improve Performance. |
| 86294-CPT | Low | Immune Test For Tumor, This Blood Test Checks For Specific Antigens Associated With A Tumor. If Present The Antigens Will Attach To Antibodies (Immune Response). |
| 86301-CPT | Low | Cancer Treatment Assessment, This Test Helps The Doctor Determine If Cancer Of The Pancreas Or Bile Ducts Is Present. It May Also Identify Treatment Response And Whether Or Not The Cancer Has Returned. |
| 86304-CPT | Low | Cancer Treatment Assessment, This Assessment Measures Treatment Effectiveness And Identifies Whether Or Not A Cancer Has Returned. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86277. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86277 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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