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See a sample rate comparisonCPT 86364 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.
Tissue Transglutaminase Test, A Tissue Transglutaminase Test Is Used To Help Diagnose Celiac Disease. This Autoimmune Disorder Causes An Immune Reaction To Eating Gluten.
| 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 91 - Repeat Lab Test |
| Complexity Level | Low |
| Medicare Fee Schedule | $11.53 national lab fee schedule rate (2026) · View Medicare rates for 86364 |
| Medicaid Fee Schedule | $10.605 median of the 8 states in the free preview · View Medicaid rates for 86364 |
National average reimbursement for CPT 86364 by major payers:
$9.84
$7.07
$12.23
$42.83
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CPT 86364
5 of 25 sample ratesHigher to lower in this preview
Christine Munson
Neuroscience Group Of Northeast Wisconsin, S.C.
$28.79Published rateJenna Kadlec
Neuroscience Group Of Northeast Wisconsin, S.C.
$28.39Published rateCovenant Medical Center
$13.84Published ratePhysicians Surgical Hospitals, LLC
Physicians Surgical Hospitals LLC
$11.52Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$6.23Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86364 vs. Other Immunology Procedures Codes
The CPT 86364 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 86364 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 |
|---|---|---|
| 86360-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. |
| 86361-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. |
| 86362-CPT | Low | Test For Autoimmune Disorder, This Test Looks For Antibodies That Are Present In Myelin-Oligodendrocyte Glycoprotein Antibody-Associated Disease (Mogad) An Autoimmune Disorder. |
| 86364-CPT | Low | Tissue Transglutaminase Test, A Tissue Transglutaminase Test Is Used To Help Diagnose Celiac Disease. This Autoimmune Disorder Causes An Immune Reaction To Eating Gluten. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86364. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86364 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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