CPT 86481 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 |
National average reimbursement for CPT 86481 by major payers:
$78.35
$58.14
$96.83
$172.90
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 86481 | ||||||
United | 86481 | $42.00 | 1336583467 - SUNNY PATEL | 830776929 - (TX) DFW RHEUMATOLOGY PLLC | TX | Rheumatology Physician (207RR0500X) |
United | 86481 | $42.00 | 1750523692 - ARIF SHAHZAD | 842347521 | TX | Rheumatology Physician (207RR0500X) |
United | 86481 | $36.63 | 1861466815 - LESLIE WILSON | 760528826 - (TX) MILLENNIUM PHYSICIANS ASSOCIATION, PLLC | TX | Rheumatology Physician (207RR0500X) |
United | 86481 | $42.00 | 1821222084 - PRIYANKA JALANDHARA | 843999306 - (TX) TARRANT ARTHRITIS CENTER LLC | TX | Rheumatology Physician (207RR0500X) |
United | 86481 | $65.00 | 1598944027 - ZOHAIR ABBAS | 161533232 - KALEIDA HEALTH | TX | Rheumatology Physician (207RR0500X) |
United | 86481 | $61.00 | 1457918096 - EMILY MOLINA | 464454096 - (TX) ARTHRITIS CLINIC OF CYPRESS & KATY, P.A. | TX | Rheumatology Physician (207RR0500X) |
United | 86481 | $100.00 | 1104649813 - DEBORAH KOH | 760010407 | TX | Rheumatology Physician (207RR0500X) |
United | 86481 | $42.00 | 1154306603 - DAVID PETROS | 50592086 - (TX) ADRIANA POP-MOODY, MD, CLINIC, PA | TX | Rheumatology Physician (207RR0500X) |
United | 86481 | $43.61 | 1083814057 - SERGIO LEON | 453358138 - (VA) ARTHRITIS AND OSTEOPOROSIS CENTER OF FAIRFAX PC | TX | Rheumatology Physician (207RR0500X) |
United | 86481 | $42.00 | 1346256773 - ATUL SINGHAL | 273065984 - (TX) SENIORSOLUTIONS HOUSECALLS LLC | TX | Rheumatology Physician (207RR0500X) |
United | 86481 | $60.00 | 1982086583 - NABILA ZAMIR | 232700908 - (PA) LEHIGH VALLEY PHYSICIAN GROUP | TX | Rheumatology Physician (207RR0500X) |
United | 86481 | $61.00 | 1710970199 - JOHN GOMEZ | 812749870 - (TX) RHEUMATOLOGY AND INFECTIOUS DISE | TX | Rheumatology Physician (207RR0500X) |
United | 86481 | $42.00 | 1992334106 - LOMIBAO RHEUMATOLOGY AND WELLNESS CARE PLLC | 844541485 - (TX) LOMIBAO RHEUMATOLOGY AND WELLNESS CARE PLLC | TX | Rheumatology Physician (207RR0500X) |
United | 86481 | $42.00 | 1578562278 - RICHARD STERN | 921383306 - (TX) NORTH TEXAS CENTER FOR RHEUMATOLOGY | TX | Rheumatology Physician (207RR0500X) |
United | 86481 | $60.00 | 1659453306 - SCOTT STEIN | 742861393 - (TX) SCOTT P. STEIN, D.O., P.A. | TX | Rheumatology Physician (207RR0500X) |
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 86481 vs. Other Immunology Procedures Codes
The CPT 86481 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 86481 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 |
|---|---|---|
| 86480-CPT | Low | Tuberculosis Test, Cell Mediated Immunity Measurement Of Gamma Interferon Antigen Response |
| 86481-CPT | Low | Tuberculosis Test, Cell Mediated Immunity Antigen Response Measurement; Enumeration Of Gamma Interferon-Producing T-Cells In Cell Suspension |
| 86485-CPT | Low | Skin Test Candida |
| 86486-CPT | Low | Lab Tests Other Nonmedicare Fee Schedule |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86481. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86481 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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