CPT 86328 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 | • 81 - Independent Laboratory • None • 11 - Office |
| Common Modifiers | • None • QW - CLIA Waived Tests • CS - COVID-19 testing cost-sharing |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86328 |
National average reimbursement for CPT 86328 by major payers:
$38.35
$37.05
$50.94
$80.39
| 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 86328 | ||||||
United | 86328 | $76.58 | 1174788913 - RIA GRIPALDO | 582030692 - EMORY UNIVERSITY | MN | Pulmonary Disease Physician (207RP1001X) |
United | 86328 | $31.65 | 1235491408 - BENJAMIN BEVILL | 311626179 - (TN) UNIVERSITY HEALTH SYSTEMS INC | TN | Pulmonary Disease Physician (207RP1001X) |
United | 86328 | $31.20 | 1730133547 - RAVI CHANDRAN | 811156192 - TMC MEDICAL NETWORK | SC | Pulmonary Disease Physician (207RP1001X) |
United | 86328 | $45.22 | 1649459942 - RAJU THAKOR | 581728803 - NOVANT MEDICAL GROUP INC | SC | Pulmonary Disease Physician (207RP1001X) |
United | 86328 | $45.22 | 1588748461 - DAVID ZAAS | 223849199 - WAKE FOREST UNIVERSITY HEALTH SCIENCES | SC | Pulmonary Disease Physician (207RP1001X) |
United | 86328 | $38.45 | 1093592644 - ANSIBLE HEALTH MEDICAL GROUP PA | 883238466 | PA | Pulmonary Disease Physician (207RP1001X) |
United | 86328 | $76.58 | 1174788913 - RIA GRIPALDO | 582030692 - EMORY UNIVERSITY | SC | Pulmonary Disease Physician (207RP1001X) |
United | 86328 | $27.13 | 1336522135 - MATTHEW VARNER | 471345819 - (SC) PRISMA HEALTH MEDICAL GROUP-MIDLANDS | SC | Pulmonary Disease Physician (207RP1001X) |
United | 86328 | $40.70 | 1730122375 - ZOTHANMAWII KHIANGTE | 461177336 - ST PETERS HEALTH PARTNERS MEDICAL ASSOCIATES PC | SC | Pulmonary Disease Physician (207RP1001X) |
United | 86328 | $38.45 | 1093592644 - ANSIBLE HEALTH MEDICAL GROUP PA | 883238466 | SD | Pulmonary Disease Physician (207RP1001X) |
United | 86328 | $54.27 | 1417019753 - PHILIP HUSBAND | 264529552 - (IN) INDIANA CLINIC CRITICAL CARE LLC | SC | Pulmonary Disease Physician (207RP1001X) |
United | 86328 | $40.70 | 1710942305 - GREGORY FELDMAN | 853861695 - MUSC COMMUNITY PHYSICIANS | SC | Pulmonary Disease Physician (207RP1001X) |
United | 86328 | $45.22 | 1912341264 - PAUL BRASHER | 611197638 - OWENSBORO HEALTH MEDICAL GROUP INC | SC | Pulmonary Disease Physician (207RP1001X) |
United | 86328 | $27.13 | 1801178645 - DANIEL LOVERDE | 571004971 - PRISMA HEALTH-UNIVERSITY MEDICAL GROUP | SC | Pulmonary Disease Physician (207RP1001X) |
United | 86328 | $31.65 | 1740280841 - THOMAS KAELIN | 300150674 - (SC) SUMMERVILLE SLEEP CONSULTANTS LLC | SC | Pulmonary Disease Physician (207RP1001X) |
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 86328 vs. Other Immunology Procedures Codes
The CPT 86328 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 86328 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 |
|---|---|---|
| 86317-CPT | Low | Immunoassay For Infec.Agent Antigen/Anti |
| 86318-CPT | Low | Immunoassay For Infectious Agent Antibody Qualitative Or Semiquantitative Single Step Method (Eg Reagent Strip); (Desc Rvsd 04/10/20) |
| 86328-CPT | Low | 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]) |
| 86329-CPT | Low | Immunodiffusion;Quantitative,Ea.Lga,Lgg, |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86328. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86328 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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