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CPT 86320 Fee Schedule

Last Verified: December 2025

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.

Immunoelectrophoresis Serum
Key FactDetail
Service Type

Pathology and Laboratory Procedures

Immunology Procedures

Common Place of Service

22 - On Campus Outpatient Hospital

81 - Independent Laboratory

Common Modifiers

None

26 - Professional component

Q1 - Routine clinical service provided in a clinical research study

Complexity LevelLow
CMS$17.14 Physician Fee Schedule

National average reimbursement for CPT 86320 by major payers:

bcbs

$27.67

uhc

$18.14

aetna

$30.68

cigna

$40.98

Preview provider-level rates for...
For billing codeCPT 86320
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for CPT 86320

United
86320$12.561952557498 - JEREMY KELLEY451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALFamily Nurse Practitioner (363LF0000X)
United
86320$12.561790057420 - BAMA HEART DOC, P.C., ALABAMA HEART AND VASCULAR MEDICINE451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALInterventional Cardiology Physician (207RI0011X)
United
86320$12.561013553197 - AMY MOORE451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALAcute Care Nurse Practitioner (363LA2100X)
United
86320$8.021790057420 - BAMA HEART DOC, P.C., ALABAMA HEART AND VASCULAR MEDICINE451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALInterventional Cardiology Physician (207RI0011X)
United
86320$12.561790057420 - BAMA HEART DOC, P.C., ALABAMA HEART AND VASCULAR MEDICINE451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALInterventional Cardiology Physician (207RI0011X)
United
86320$12.561831220904 - METHODIST HOSPITAL PLAINVIEW TEXAS, COVENANT HOSPITAL PLAINVIEW752426010 - (TX) METHODIST HOSPITAL PLAINVIEW TEXASTXGeneral Acute Care Hospital (282N00000X)
United
86320$31.311558311936 - TEMPLE VAMC742791419TXGeneral Acute Care Hospital (282N00000X)
United
86320$29.921730730490 - US HEALTH PARTNERS, LLC843119330 - (TX) US HEALTH PARTNERS LLCTXGeneral Acute Care Hospital (282N00000X)
United
86320$29.921023065794 - CHCA WOMANS HOSPITAL LP, WOMAN'S HOSPITAL OF TEXAS621810381 - (TX) CHCA WOMANS HOSPITAL LPTXGeneral Acute Care Hospital (282N00000X)
United
86320$13.141700854288 - LAMB HEALTHCARE CENTER752388515 - (TX) LAMB HEALTHCARE CENTERTXGeneral Acute Care Hospital (282N00000X)
United
86320$30.751588654966 - ST. JAMES PARISH HOSP. SERV. DIST.726010747 - (LA) ST JAMES PARISH HOSPITALLACritical Access Hospital (282NC0060X)
United
86320$26.931396520862 - LAKE SURGICAL HOSPITAL SLIDELL, LLC474228147 - (LA) LAKE SURGICAL HOSPITAL SLIDELL, LLC DBA SOUTHERN SURGICAL HOSPITALLAGeneral Acute Care Hospital (282N00000X)
United
86320$13.341144766569 - PARAGON HOSPITALIST, LLC814432519 - (TX) PARAGON HOSPITALIST LLCTXGeneral Acute Care Hospital (282N00000X)
United
86320$10.771568848059 - CUMBERLAND SURGICAL HOSPITAL OF SAN ANTONIO LLC, LEGENT ORTHOPEDIC & SPINE474612520TXGeneral Acute Care Hospital (282N00000X)
United
86320$29.921255384533 - COLUMBIA MEDICAL CENTER OF LEWISVILLE SUBSIDIARY LP, MEDICAL CITY LEWISVILLE621682210 - (TX) DE MARKETING AND SALESTXGeneral Acute Care Hospital (282N00000X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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CPT 86320 vs. Other Immunology Procedures Codes

The CPT 86320 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 86320 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.

CodeComplexityDescription
86200-CPTLowCyclic Citrullinated Peptide Antibody
86316-CPTLowImmunoassay For Tumor Antigen; Other Antigen, Quantitative (Eg, Ca 50, 72-4, 549), Each
86318-CPTLowImmunoassay For Infectious Agent Antibody Qualitative Or Semiquantitative Single Step Method (Eg Reagent Strip); (Desc Rvsd 04/10/20)
86320-CPTLowImmunoelectrophoresis Serum

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86320. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 86320 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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