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See a sample rate comparisonCPT 86309 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.
Heterophile Antibodies Titer, Heterophile Antibodies Titer (Closest Clinically Equivalentcode(S) Deleted In 1993 86305) Heterophile Antibodies Titer (Closest Clinically Equivalent
| 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 QW - CLIA Waived Tests |
| Complexity Level | Low |
| Medicare Fee Schedule | $6.47 national lab fee schedule rate (2026) · View Medicare rates for 86309 |
| Medicaid Fee Schedule | $6.39 median of the 8 states in the free preview · View Medicaid rates for 86309 |
National average reimbursement for CPT 86309 by major payers:
$5.88
$4.69
$7.44
$9.52
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CPT 86309
5 of 25 sample ratesHigher to lower in this preview
All Ways Homecare Inc
$60.00Published rateHuntsville Community Hospital, Inc.
Huntsville Community Hospital Inc
$8.14Published ratePrisma Health-Upstate
Prisma Health - Upstate
$5.82Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$3.88Published rateE And A Medical On The Go Healthcare Of South Florida LLC, E And A Healthcare On The Go
E And A Medical On The Go Healthcare Of South Florida LLC
$2.25Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86309 vs. Other Immunology Procedures Codes
The CPT 86309 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 86309 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 |
|---|---|---|
| 86308-CPT | Low | Heterophile Antibodies Screen, Heterophile Antibodies Screening (Closest Clinicallyequivalent Code(S) Deleted In 1993 86300) Heterophile Antibodies Screening (Closest Clinically |
| 86309-CPT | Low | Heterophile Antibodies Titer, Heterophile Antibodies Titer (Closest Clinically Equivalentcode(S) Deleted In 1993 86305) Heterophile Antibodies Titer (Closest Clinically Equivalent |
| 86310-CPT | Low | Heterophile Antibodies Titers, Heterophile Antibodies Titers After Absorption With Beefcells And Guinea Pig Kidney Heterophile Antibodies Titers After Absorption With Beef |
| 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 86309. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86309 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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