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See a sample rate comparisonCPT 86343 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.
Allergy Blood Test, This Allergy Blood Test Verifies Sensitivity To A Specific Trigger. Different Amounts Of The Allergen Are Added To Blood Samples. The Quantity Of Histamine Released From The White Blood Cells In Each Sample Is Then Measured.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 90 - Reference Laboratory GA - Required ABN issued and on file |
| Complexity Level | Low |
| Medicare Fee Schedule | $12.46 national lab fee schedule rate (2026) · View Medicare rates for 86343 |
| Medicaid Fee Schedule | $11.465 median of the 8 states in the free preview · View Medicaid rates for 86343 |
National average reimbursement for CPT 86343 by major payers:
$11.00
$8.96
$15.81
$18.45
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CPT 86343
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$27.41Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$12.60Published rateEmerus Bhs Sa Thousand Oaks, LLC, Baptist Neighborhood Hospital Overlook
Emerus Bhs Sa Thousand Oaks LLC
$12.46Published rateChristus Health Ark-La-Tex, Christus St. Michael Health System
Christus Trinity Clinic
$7.48Published rateBrittany Ptachick
Hroa 401k Plan
$5.23Published rate
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See a sample payer proposalCPT 86343 vs. Other Immunology Procedures Codes
The CPT 86343 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 86343 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 |
|---|---|---|
| 86332-CPT | Low | Immune Pair Testing, An Immune Complex Is An Antibody Attached To Its Corresponding Antigen. This Test Identifies All Pairs Present In A Blood Sample. Immune Complexes Play A Role In Autoimmune Diseases. |
| 86334-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. |
| 86335-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. |
| 86343-CPT | Low | Allergy Blood Test, This Allergy Blood Test Verifies Sensitivity To A Specific Trigger. Different Amounts Of The Allergen Are Added To Blood Samples. The Quantity Of Histamine Released From The White Blood Cells In Each Sample Is Then Measured. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86343. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86343 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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