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See a sample rate comparisonCPT 86381 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.
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.
| 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 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $25.45 national lab fee schedule rate (2026) · View Medicare rates for 86381 |
| Medicaid Fee Schedule | $25.13 median of the 8 states in the free preview · View Medicaid rates for 86381 |
National average reimbursement for CPT 86381 by major payers:
$21.38
$15.68
$24.48
$62.83
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CPT 86381
5 of 25 sample ratesHigher to lower in this preview
Kevin Deboer
Florida Hospital Medical Group Inc
$29.29Published rateOn Site Dermatology Associates LLC
$11.44Published rateBrian Pickens
North Florida Surgical Associates LLC
$10.68Published rateAyisha Livingstone
Meli Orthopedic Center Of Excellenc
$8.90Published rateMarian Ibrahim
Douglas K Pierce Md PA
$8.90Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86381 vs. Other Immunology Procedures Codes
The CPT 86381 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 86381 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 86381. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86381 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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