CPT 86317 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 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86317 |
| Medicaid Fee Schedule | View Medicaid rates for 86317 |
National average reimbursement for CPT 86317 by major payers:
$13.29
$10.84
$17.05
$21.69
CPT 86317 vs. Other Immunology Procedures Codes
The CPT 86317 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 86317 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 |
|---|---|---|
| 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. |
| 86317-CPT | Low | Immunity Test, Immunity Tests Identify Specific Antibodies And Measure The Level Of Immunity (Resistance) That The Antibody Provides. This Test Can Be Used To Assess The Effectiveness Of A Vaccination. |
| 86318-CPT | Low | Immunity Test, Immunity Tests Identify Specific Antibodies And Measure The Level Of Immunity (Resistance) That The Antibody Provides. This Test Can Be Used To Assess The Effectiveness Of A Vaccination. |
| 86328-CPT | Low | Ia Nfct Ab Sarscov2 Covid19, Immunoassay For Infectious Agent Antibody Ies Qualitative Or Semiquantitative Single Step Method Eg Reagent Strip Severe Acute Respiratory Syndrome Coronavirus 2 Sars Cov 2 Coronavirus Disease Covid 19 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86317. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86317 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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