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See a sample rate comparisonCPT 86305 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.
Ovarian Cancer Blood Test, This Test Checks A Blood Sample For Glycoprotein Which Can Help In The Diagnosis Of Ovarian Cancer.
| 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 | $20.81 national lab fee schedule rate (2026) · View Medicare rates for 86305 |
| Medicaid Fee Schedule | $20.34 median of the 8 states in the free preview · View Medicaid rates for 86305 |
National average reimbursement for CPT 86305 by major payers:
$18.20
$14.69
$25.28
$56.46
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CPT 86305
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$45.78Published rateChristopher Raio
St Joseph Hospital
$24.72Published rateBradley Weisner
Urology Specialists Of The Carolinas, PLLC
$14.91Published rateLeon Home Health, LLC, Leon At Home
$11.89Published rateBrittany Ptachick
Hroa 401k Plan
$8.74Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86305 vs. Other Immunology Procedures Codes
The CPT 86305 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 86305 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 86305. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86305 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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