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See a sample rate comparisonCPT 86320 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.
Test Of Immune Activity, This Test Helps Diagnose And Monitor Multiple Diseases. It Measures A Decrease Or Increase Of Immune System Proteins (Globulins). The Sample Can Be Blood Urine Or Spinal Fluid.
| 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 | 26 - Professional component Q1 - Routine clinical service provided in a clinical research study |
| Complexity Level | Low |
| Medicare Fee Schedule | $29.92 national lab fee schedule rate (2026) · View Medicare rates for 86320 |
| Medicaid Fee Schedule | $27.90 median of the 8 states in the free preview · View Medicaid rates for 86320 |
National average reimbursement for CPT 86320 by major payers:
$27.67
$18.14
$30.68
$39.60
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CPT 86320
5 of 25 sample ratesHigher to lower in this preview
Citizens Medical Center County Of Victoria, County Of Victoria Citizens Medical Center
$61.00Published rateMethodist Hospitals Of Dallas, Methodist Mansfield Medical Center
Methodist Hospitals Of Dallas
$29.92Published rateClhg-Ville Platte LLC, Mercy Regional Medical Center
$28.57Published ratePalo Pinto County Hospital District, Palo Pinto General Hospital
$13.14Published rateAscension Seton, Ascension Seton Medical Center Austin
Ascension Seton
$6.51Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 |
|---|---|---|
| 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. |
| 86320-CPT | Low | Test Of Immune Activity, This Test Helps Diagnose And Monitor Multiple Diseases. It Measures A Decrease Or Increase Of Immune System Proteins (Globulins). The Sample Can Be Blood Urine Or Spinal Fluid. |
| 86325-CPT | Low | Test Of Immune Activity, This Test Helps Diagnose And Monitor Multiple Diseases. It Measures A Decrease Or Increase Of Immune System Proteins (Globulins). The Sample Can Be Blood Urine Or Spinal Fluid. |
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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