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See a sample rate comparisonCPT 86609 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.
Antibody Bacterium Nes
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $12.88 national lab fee schedule rate (2026) · View Medicare rates for 86609 |
| Medicaid Fee Schedule | $11.85 median of the 8 states in the free preview · View Medicaid rates for 86609 |
National average reimbursement for CPT 86609 by major payers:
$11.54
$13.28
$13.90
$18.91
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CPT 86609
5 of 25 sample ratesHigher to lower in this preview
All Ways Homecare Inc
$60.00Published rateChristopher Raio
Mercy Medical Center
$15.30Published ratePrisma Health-Upstate, Prisma Health Center For Pediatric Med
Prisma Health - Upstate
$11.59Published rateBradley Weisner
Urology Specialists Of The Carolinas, PLLC
$8.91Published rateChristopher Raio
St Joseph Hospital
$6.96Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86609 vs. Other Immunology Procedures Codes
The CPT 86609 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 86609 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 |
|---|---|---|
| 86603-CPT | Low | Adenovirus Immunity Test, The Adenovirus Immunity Test Indicates That A Person Has Been Exposed To This Virus. The Virus Causes Lymph Nodes At The Back Of The Throat To Become Enlarged Which Can Make Breathing Difficult. |
| 86606-CPT | Low | Fungal Infection Test, The Test Checks For Antibodies To Aspergillus A Common Fungus. Positive Results Indicate Current Or Past Infection. |
| 86609-CPT | Low | Antibody Bacterium Nes |
| 86611-CPT | Low | Test For Cat-Scratch Disease, This Test Detects Current Or Past Bacterial Infection From Bartonella. The Most Common Infection Is Transmitted From A Cat Scratch Or Bite. Immune-Compromised People Can React More Severely To This Bacteria. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86609. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86609 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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