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See a sample rate comparisonCPT 86353 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 Response, The Test Evaluates The Quality Of The Immune Systems Early Response Which Involves Lymphocytes (A Type Of White Blood Cell). The Test Can Help Evaluate Suspected Immune Deficiency.
| 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 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $49.03 national lab fee schedule rate (2026) · View Medicare rates for 86353 |
| Medicaid Fee Schedule | $48.415 median of the 8 states in the free preview · View Medicaid rates for 86353 |
National average reimbursement for CPT 86353 by major payers:
$42.35
$34.60
$53.20
$71.91
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CPT 86353
5 of 25 sample ratesHigher to lower in this preview
Emerus Bhs Sa Thousand Oaks, LLC, Baptist Neighborhood Hospital Hausman
Emerus Bhs Sa Thousand Oaks LLC
$120.00Published rateNatchitoches Parish Hospital Service District, Natchitoches Regional Medical Center
Natchitoches Regional Medical Center
$64.41Published rateOpelousas General Hospital Authority
$49.02Published rateSmithville Hospital Authority, Smithville Regional Hospital
$28.77Published rateAscension Seton, Ascension Seton Medical Center Austin
Ascension Seton
$18.62Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86353 vs. Other Immunology Procedures Codes
The CPT 86353 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 86353 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 |
|---|---|---|
| 86352-CPT | Low | Test For Biomarker, A General Test Of A Sample Of Cells Looking For A Biomarker. A Biomarker Is A Chemical Made By The Body That Is Important To A Specific Function. |
| 86353-CPT | Low | Test Of Immune Response, The Test Evaluates The Quality Of The Immune Systems Early Response Which Involves Lymphocytes (A Type Of White Blood Cell). The Test Can Help Evaluate Suspected Immune Deficiency. |
| 86355-CPT | Low | Blood B-Cell Count, This Test Counts B Cells (White Blood Cells Found In Bones) Which Are Markers For Immune System Function. They Help Physicians Understand The Bodys Needs For An Anticipated Transplant. |
| 86356-CPT | Low | Mononuclear Cell Antign Quantita (Eg Flow Cytometry) Not Other, Mononuclear Cell Antigen Quantitative (Eg Flow Cytometry) Not Other |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86353. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86353 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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