CPT 86316 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None 90 - Reference Laboratory 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86316 |
| Medicaid Fee Schedule | View Medicaid rates for 86316 |
National average reimbursement for CPT 86316 by major payers:
$18.44
$14.76
$24.40
$30.05
CPT 86316 vs. Other Immunology Procedures Codes
The CPT 86316 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 86316 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 |
|---|---|---|
| 86140-CPT | Low | Blood Test For Inflammation, This Test Measures A Protein That Is An Indicator Of Inflammation Related To Bacteria And Tissue Damage. |
| 86141-CPT | Low | Blood Test For Inflammation, This Test Measures A Protein That Is An Indicator Of Inflammation Related To Bacteria And Tissue Damage. |
| 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. |
| 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 86316. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86316 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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