CPT 86320 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 | • 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 Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86320 |
National average reimbursement for CPT 86320 by major payers:
$27.67
$18.14
$30.68
$40.98
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 86320 | ||||||
United | 86320 | $13.14 | 1457358103 - BELLVILLE HOSPITAL DISTRICT, BELLVILLE GENERAL HOSPITAL | 760636528 | TX | General Acute Care Hospital (282N00000X) |
United | 86320 | $19.04 | 1235685892 - FAIRFIELD HOSPITAL DISTRICT, FREESTONE MEDICAL CENTER | 741774669 | TX | General Acute Care Hospital (282N00000X) |
United | 86320 | $6.51 | 1164526786 - ASCENSION SETON, ASCENSION SETON MEDICAL CENTER AUSTIN | 741109643 - ASCENSION SETON | TX | General Acute Care Hospital (282N00000X) |
United | 86320 | $12.56 | 1013553197 - AMY MOORE | 451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINE | AL | Acute Care Nurse Practitioner (363LA2100X) |
United | 86320 | $8.02 | 1790057420 - BAMA HEART DOC, P.C., ALABAMA HEART AND VASCULAR MEDICINE | 451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINE | AL | Interventional Cardiology Physician (207RI0011X) |
United | 86320 | $29.92 | 1508810573 - BAY AREA HEALTHCARE GROUP, LTD., CORPUS CHRISTI MEDICAL CENTER | 752387418 | TX | General Acute Care Hospital (282N00000X) |
United | 86320 | $29.92 | 1689629941 - METHODIST HOSPITALS OF DALLAS, METHODIST MANSFIELD MEDICAL CENTER | 750800661 - METHODIST HOSPITALS OF DALLAS | TX | General Acute Care Hospital (282N00000X) |
United | 86320 | $60.00 | 1841844735 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL KELLY | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 86320 | $28.57 | 1407947336 - CLHG-VILLE PLATTE LLC, MERCY REGIONAL MEDICAL CENTER | 824681222 | LA | General Acute Care Hospital (282N00000X) |
United | 86320 | $13.14 | 1972590602 - PALO PINTO COUNTY HOSPITAL DISTRICT, PALO PINTO GENERAL HOSPITAL | 751256948 | TX | General Acute Care Hospital (282N00000X) |
United | 86320 | $44.88 | 1184622847 - CHI ST. LUKE'S HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER | 741161938 - CHI ST LUKES HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 86320 | $29.92 | 1003925959 - HOSPITAL SERVICE DISTRICT 2 OF THE PARISH OF TANGIPAHOA STATE OF LA., HOOD MEMORIAL HOSPITAL | 720694946 - (LA) HOSPITAL SERVICE DISTRICT 2 OF THE PARISH OF TANGIPAHOA STATE OF LA | LA | Critical Access Hospital (282NC0060X) |
United | 86320 | $12.81 | 1124076401 - DECATUR HOSPITAL AUTHORITY, WISE HEALTH SYSTEM | 751250450 - (TX) DECATUR HOSPITAL AUTHORITY | TX | General Acute Care Hospital (282N00000X) |
United | 86320 | $12.56 | 1831220904 - METHODIST HOSPITAL PLAINVIEW TEXAS, COVENANT HOSPITAL PLAINVIEW | 752426010 - (TX) METHODIST HOSPITAL PLAINVIEW TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 86320 | $29.92 | 1447230388 - OPELOUSAS GENERAL HOSPITAL AUTHORITY | 720708111 | LA | General Acute Care Hospital (282N00000X) |
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 |
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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.
| Code | Complexity | Description |
|---|---|---|
| 86200-CPT | Low | Cyclic Citrullinated Peptide Antibody |
| 86316-CPT | Low | Immunoassay For Tumor Antigen; Other Antigen, Quantitative (Eg, Ca 50, 72-4, 549), Each |
| 86318-CPT | Low | Immunoassay For Infectious Agent Antibody Qualitative Or Semiquantitative Single Step Method (Eg Reagent Strip); (Desc Rvsd 04/10/20) |
| 86320-CPT | Low | Immunoelectrophoresis 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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