CPT 86359 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 11 - Office |
| Common Modifiers | None 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86359 |
| Medicaid Fee Schedule | View Medicaid rates for 86359 |
National average reimbursement for CPT 86359 by major payers:
$32.41
$32.96
$40.75
$54.33
CPT 86359 vs. Other Immunology Procedures Codes
The CPT 86359 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 86359 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. |
| 86359-CPT | Low | Blood T-Cell Count, This Test Counts T Cells A Type Of White Blood Cell. T Cells Help The Body Fight Diseases And Are Key To Evaluating Overall Function Of The Immune System. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86359. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86359 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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