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See a sample rate comparisonCPT 86301 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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $20.81 national lab fee schedule rate (2026) · View Medicare rates for 86301 |
| Medicaid Fee Schedule | $20.55 median of the 8 states in the free preview · View Medicaid rates for 86301 |
National average reimbursement for CPT 86301 by major payers:
$18.47
$14.72
$25.05
$29.81
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CPT 86301
5 of 25 sample ratesHigher to lower in this preview
Hans Gerdes
$78.44Published rateRobert Gianotti
Albany Medical College
$30.06Published rateAnil Rustgi
$19.77Published rateSunil Khurana
Premier Medical Group Of The Hudson Valley, PC
$12.48Published rateViyada Sarabanchong
Gastrointestinal Care Of Long Is
$7.42Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86301 vs. Other Immunology Procedures Codes
The CPT 86301 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 86301 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 |
|---|---|---|
| 86300-CPT | Low | Immunoassay For Tumor Antigen, Quantitative; Ca 15-3 |
| 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. |
| 86305-CPT | Low | Ovarian Cancer Blood Test, This Test Checks A Blood Sample For Glycoprotein Which Can Help In The Diagnosis Of Ovarian Cancer. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86301. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86301 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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