CPT 86357 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 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 26 - Professional component 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86357 |
National average reimbursement for CPT 86357 by major payers:
$32.51
$25.95
$39.69
$76.46
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 86357 | $22.63 | 1982808689 - TIMOTHY KUBAL | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Hematology & Oncology Physician (207RH0003X) |
United | 86357 | $22.63 | 1639599665 - JULIE LI | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Hematology (Pathology) Physician (207ZH0000X) |
United | 86357 | $19.23 | 1003941543 - PATRICIA RABON | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Physician Assistant (363A00000X) |
United | 86357 | $22.63 | 1003201096 - MICHAEL WACH | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Surgical Oncology Physician (2086X0206X) |
United | 86357 | $19.23 | 1417496696 - RACHEL NAHRWOLD | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Nurse Practitioner (363L00000X) |
United | 86357 | $22.63 | 1588870323 - EVAN WUTHRICK | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | OH | Radiation Oncology Physician (2085R0001X) |
United | 86357 | $45.27 | 1073576740 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, VALLEYWISE HEALTH | 860830701 | AZ | General Acute Care Hospital (282N00000X) |
United | 86357 | $19.23 | 1780373043 - ALLY NEAL | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | KY | Student in an Organized Health Care Education/Training Program (390200000X) |
United | 86357 | $19.23 | 1346281755 - ELIZABETH MATOS-BERK | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Nurse Practitioner (363L00000X) |
United | 86357 | $22.63 | 1063517779 - PEDRO CANO | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Clinical Pathology Physician (207ZC0006X) |
United | 86357 | $22.63 | 1134757206 - DAVID SCHOENFELD | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Internal Medicine Physician (207R00000X) |
United | 86357 | $22.63 | 1568791994 - ADDISON CHAN | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | CA | Emergency Medicine Physician (207P00000X) |
United | 86357 | $19.23 | 1154342897 - HEATHER ROULSTONE | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Physician Assistant (363A00000X) |
United | 86357 | $19.23 | 1437721206 - DANIEL JOE | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Anesthesiologist Assistant (367H00000X) |
United | 86357 | $22.63 | 1932322054 - EDMONDO ROBINSON | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | DE | Hospitalist Physician (208M00000X) |
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 86357 vs. Other Immunology Procedures Codes
The CPT 86357 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 86357 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. |
| 86357-CPT | Low | Natural Killer Cell Study, Natural Killer (Nk) Cells Are White Blood Cells That Release A Chemical Toxic To Cancer Cells. The Chemical Also Can Induce Miscarriage In Early Pregnancy. The Study Observes The Effectiveness And Activity Of Nk Cells From A Blood Sample. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86357. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86357 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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