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See a sample rate comparisonCPT 86280 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.
Immune Response Test, This Immune Test Evaluates The Strength Of Intruder Agents And Identifies Weakness In The Immune Systems Ability To Expell Unwanted Agents.
| 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 | $8.19 national lab fee schedule rate (2026) · View Medicare rates for 86280 |
| Medicaid Fee Schedule | $8.09 median of the 8 states in the free preview · View Medicaid rates for 86280 |
National average reimbursement for CPT 86280 by major payers:
$7.56
$5.87
$8.99
$12.10
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CPT 86280
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$18.02Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$9.73Published rateHenderson Hospital, LLC, Uthealth East Texas Henderson Hospital
$8.18Published rateJones County Regional Healthcare System, Stamford Memorial Hospital
Jones County Regional Healthcare System
$4.80Published rateChristus Health Ark-La-Tex, Christus St. Michael Health System
Christus Health Ark-La-Tex
$4.25Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86280 vs. Other Immunology Procedures Codes
The CPT 86280 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 86280 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. |
| 86280-CPT | Low | Immune Response Test, This Immune Test Evaluates The Strength Of Intruder Agents And Identifies Weakness In The Immune Systems Ability To Expell Unwanted Agents. |
| 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). |
| 86316-CPT | Low | Cancer Treatment Assessment, This Assessment Uses A Radioactive Substance To Highlight Specific Antigens (Seen By The Immune System As Not Belonging In The Body). Antigens That Form With Tumors Can Help Determine How Well A Treatment Has Worked. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86280. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86280 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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