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See a sample rate comparisonCPT 86318 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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility 81 - Independent Laboratory |
| Common Modifiers | QW - CLIA Waived Tests 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $18.09 national lab fee schedule rate (2026) · View Medicare rates for 86318 |
| Medicaid Fee Schedule | $16.645 median of the 8 states in the free preview · View Medicaid rates for 86318 |
National average reimbursement for CPT 86318 by major payers:
$16.94
$14.42
$18.48
$22.04
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CPT 86318
5 of 25 sample ratesHigher to lower in this preview
Andrew Townsend
All About You Family Medicine PC
$18.90Published rateSoutheastern Regional Medical Center, Inc., Southeastern Regional Medical Center, LLC
Southeastern Regional Medical Center Inc
$18.09Published rateKnox County Hospital District, Knox County Hospital District
$16.28Published rateWilliam Yang
Renal Consultants Medical Group
$10.85Published rateGonzales Healthcare Systems
$10.85Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86318 vs. Other Immunology Procedures Codes
The CPT 86318 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 86318 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 86318. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86318 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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