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See a sample rate comparisonCPT 86386 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.
Bladder Cancer Genetic Test, A Lab Test To Analyze A Sample For The Presence Of Nuclear Matrix Protein 22 Which Is Considered To Be A Marker For Bladder Cancer.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 11 - Office 81 - Independent Laboratory |
| Common Modifiers | QW - CLIA Waived Tests GZ - Item or Service Expected to Be Denied as Not Reasonable and Necessary |
| Complexity Level | Low |
| Medicare Fee Schedule | $21.78 national lab fee schedule rate (2026) · View Medicare rates for 86386 |
| Medicaid Fee Schedule | $21.56 median of the 8 states in the free preview · View Medicaid rates for 86386 |
National average reimbursement for CPT 86386 by major payers:
$18.93
$13.10
$20.82
$56.05
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CPT 86386
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$47.92Published rateTenet Hospitals Limited, The Hospitals Of Providence Memorial Campus
$21.78Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$14.48Published rateNevada Eye Care Professionals Little & Stein, Ltd.
Nevada Eye Care Professionals
$9.50Published rateE And A Medical On The Go Healthcare Of South Florida LLC, E And A Healthcare On The Go
E And A Medical On The Go Healthcare Of South Florida LLC
$7.61Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86386 vs. Other Immunology Procedures Codes
The CPT 86386 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 86386 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. |
| 86386-CPT | Low | Bladder Cancer Genetic Test, A Lab Test To Analyze A Sample For The Presence Of Nuclear Matrix Protein 22 Which Is Considered To Be A Marker For Bladder Cancer. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86386. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86386 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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