CPT 86376 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 86376 |
National average reimbursement for CPT 86376 by major payers:
$12.78
$10.86
$17.86
$20.96
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 86376 | $11.90 | 1700271343 - STUART SHAH | 351972384 - PARKVIEW HEALTH SYSTEM INC | FL | Pulmonary Disease Physician (207RP1001X) |
United | 86376 | $5.09 | 1356552178 - VAREE POOCHAREON | 650932856 - (FL) ARTHUR S. COLSKY, M.D., PH.D., P.A. D/B/A SKIN CEN | FL | Dermatology Physician (207N00000X) |
United | 86376 | $5.09 | 1831296607 - MANUEL RAMOS | 1831296607 - (FL) MANUEL RAMOS | FL | Pulmonary Disease Physician (207RP1001X) |
United | 86376 | $11.18 | 1285838219 - JOHN COX | 465651894 | FL | Dermatology Physician (207N00000X) |
United | 86376 | $11.89 | 1114177433 - ARSHAD BACHELANI | 593214635 - FLORIDA HOSPITAL MEDICAL GROUP INC | FL | Surgery Physician (208600000X) |
United | 86376 | $5.09 | 1326332206 - MICHAEL TYLER | 202763393 - (FL) MICHAEL P ZAHALSKY MD PA | FL | Urology Physician (208800000X) |
United | 86376 | $8.72 | 1114033453 - MICHAEL NEWAN | 593692217 - (FL) MICHAEL M NEWAN MD PA | FL | Pulmonary Disease Physician (207RP1001X) |
United | 86376 | $5.09 | 1003845504 - HAROLD TSAI | 852305191 - (FL) INSPIRE ONCOLOGY LLC | FL | Urology Physician (208800000X) |
United | 86376 | $8.72 | 1235709528 - ACADEMIC ALLIANCE IN DERMATOLOGY, INC | 592897287 - (FL) ACADEMIC ALLIANCE IN DERMATOLOGY, INC. | FL | Dermatology Physician (207N00000X) |
United | 86376 | $6.11 | 1205015427 - JAMES WILLIAMS | 852733660 | FL | Colon & Rectal Surgery Physician (208C00000X) |
United | 86376 | $6.11 | 1639674872 - TIMOTHY JUWONO | 270271872 | FL | Urology Physician (208800000X) |
United | 86376 | $6.11 | 1891735858 - AMY WATSON | 542149912 - (FL) DERMATOLOGY ASSOCIATES OF NORTHWEST FLORIDA, P.A. | FL | Dermatology Physician (207N00000X) |
United | 86376 | $8.38 | 1942252317 - NAEEM AHMED | 815111951 - (FL) RESPIRATORY AND SLEEP DISORDERS CENTER | FL | Pulmonary Disease Physician (207RP1001X) |
United | 86376 | $8.53 | 1992920664 - GARY C CHIERICO & ASSOCIATES MD PA | 650696008 - (FL) GARY C CHIERICO ASSOCIATES MD PA | FL | Pulmonary Disease Physician (207RP1001X) |
United | 86376 | $5.09 | 1104810811 - ROBERT CONTRUCCI | 850698677 - (FL) SLEEP SNORING SINUS CLINIC OF FLORIDA LLC | FL | Otolaryngology Physician (207Y00000X) |
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 86376 vs. Other Immunology Procedures Codes
The CPT 86376 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 86376 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 |
|---|---|---|
| 86376-CPT | Low | Thyroid Autoimmune Test, This Test Detects Antibodies To A Protein In The Thyroid Gland. It Helps To Diagnose Autoimmune Conditions. |
| 86381-CPT | Low | Lab Test For Liver Disorder, This Lab Test Is Used To Determine The Presence Of Mitochondrial Antibodies Which Can Help To Diagnose Primary Biliary Cirrhosis. |
| 86382-CPT | Low | Test For Virus Source, The Virus Neutralization Test Method Identifies The Source Of An Infection By Matching Antibodies And Antigens. |
| 86384-CPT | Low | Nitroblue Dye Test, The Nitroblue Dye Test Is Used To Screen For Several Inherited Disorders And Conditions Caused By Immune Deficiencies. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86376. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86376 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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