CPT 86318 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 | 11 - Office 20 - Urgent Care Facility 81 - Independent Laboratory |
| Common Modifiers | None QW - CLIA Waived Tests 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86318 |
National average reimbursement for CPT 86318 by major payers:
$16.94
$14.42
$18.48
$22.04
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 86318 | $10.85 | 1871500389 - ANANT DESAI | 953841576 - (CA) RENAL CONSULTANTS MEDICAL GROUP | CA | Nephrology Physician (207RN0300X) |
United | 86318 | $18.09 | 1801327101 - MATTHEW WORKMAN | 320280406 - (TN) PEERLESS PEDIATRICS, PC | TN | Pediatrics Physician (208000000X) |
United | 86318 | $16.28 | 1487639175 - KNOX COUNTY HOSPITAL DISTRICT, KNOX COUNTY HOSPITAL DISTRICT | 750808798 | TX | General Acute Care Hospital (282N00000X) |
United | 86318 | $10.85 | 1164476099 - JENNIFER JEHRIO-BUTLER | 621702967 - (TN) TENNESSEE PEDIATRICS, PC | TN | Pediatrics Physician (208000000X) |
United | 86318 | $18.90 | 1740207760 - ANDREW TOWNSEND | 300386174 - (TN) ALL ABOUT YOU FAMILY MEDICINE PC | TN | Pediatrics Physician (208000000X) |
United | 86318 | $10.85 | 1609005479 - WILLIAM YANG | 953841576 - (CA) RENAL CONSULTANTS MEDICAL GROUP | CA | Nephrology Physician (207RN0300X) |
United | 86318 | $10.85 | 1164482352 - LAUREL ALSENTZER | 621551899 - (TN) PEDIATRIC ASSOCIATES OF DAVIDS | TN | Pediatrics Physician (208000000X) |
United | 86318 | $10.85 | 1982665212 - JENNIFER RAGSDALE | 621517003 - (TN) OLD HARDING PEDIATRIC ASSOCIATES, P.C. | TN | Pediatrics Physician (208000000X) |
United | 86318 | $10.85 | 1619087590 - MIGUEL ARENAS | 300394179 - (AZ) MIGUEL A ARENAS MD PC | AZ | Gastroenterology Physician (207RG0100X) |
United | 86318 | $18.09 | 1518020015 - TERESA WHITE | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Pediatrics Physician (208000000X) |
United | 86318 | $12.43 | 1548431356 - TATANISHA SMITH | 831203401 - (TN) A BRIGHTER DAY PEDIATRICS | TN | Pediatrics Physician (208000000X) |
United | 86318 | $18.09 | 1588898860 - CARRIE LIND | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Pediatrics Physician (208000000X) |
United | 86318 | $15.28 | 1588664726 - GERALD PRESBURY | 30525664 - (TN) PEDIATRIC SEDATION SPECIALISTS PC | TN | Pediatrics Physician (208000000X) |
United | 86318 | $18.90 | 1619597309 - SARAH TOLLIVER | 621052914 - MEDICAL EDUCATION ASSISTANCE CORPORATION | TN | Pediatrics Physician (208000000X) |
United | 86318 | $10.85 | 1285961789 - DAYAN GANDHI | 953841576 - (CA) RENAL CONSULTANTS MEDICAL GROUP | CA | Nephrology Physician (207RN0300X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 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 |
|---|---|---|
| 86200-CPT | Low | Rheumatoid Arthritis Test, This Test Checks For Antibodies That Are Present With Rheumatoid Arthritis. The Test Helps To Make An Accurate Diagnosis. |
| 86235-CPT | Low | Autoimmune Disease Test, This Test Detects Antibodies To Cell Components And Proteins. The Test Is Used To Diagnose And Assess Progression Of Connective Tissue Diseases. |
| 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. |
| 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. |
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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 86318) and we'll show you how you compare in 15 minutes or less.