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See a sample rate comparisonCPT 86304 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 Assessment Measures Treatment Effectiveness And Identifies Whether Or Not A 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 86304 |
| Medicaid Fee Schedule | $20.55 median of the 8 states in the free preview · View Medicaid rates for 86304 |
National average reimbursement for CPT 86304 by major payers:
$18.39
$14.72
$25.47
$29.93
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CPT 86304
5 of 25 sample ratesHigher to lower in this preview
Piedmont Newton Hospital, Inc., Newton Medical Center
Piedmont Newton Hospital Inc
$47.86Published rateSepideh Mokhtari
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$12.48Published rateAlison Walker
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$12.48Published rateNatalie Lincoln
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$10.60Published rateCharles Buerk
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$10.60Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86304 vs. Other Immunology Procedures Codes
The CPT 86304 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 86304 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 |
|---|---|---|
| 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). |
| 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. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86304. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86304 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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