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See a sample rate comparisonCPT 86611 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.
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.
| 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 | $10.18 national lab fee schedule rate (2026) · View Medicare rates for 86611 |
| Medicaid Fee Schedule | $9.55 median of the 8 states in the free preview · View Medicaid rates for 86611 |
National average reimbursement for CPT 86611 by major payers:
$9.15
$7.25
$11.27
$14.90
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CPT 86611
5 of 25 sample ratesHigher to lower in this preview
Benjamin Savage
Neuroscience Group Of Northeast Wisconsin, S.C.
$25.42Published rateFoundation Bariatric Hospital Of San Antonio, LLC, Foundation Surgical Hospital Of San Antonio
Foundation Bariatric Hospital Of San Antonio, LLC
$10.18Published rateMedical University Hospital Authority, Musc Health Marion Medical Center
Medical University Hospital Authority
$10.18Published rateLallie Kemp Medical Ctr, Lallie Kemp Regional Medical Center
$9.15Published rateNorthwest Texas Surgical Hospital, LLC, Northwest Texas Surgery Center
Northwest Texas Surgical Hospital LLC
$4.28Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86611 vs. Other Immunology Procedures Codes
The CPT 86611 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 86611 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 86611. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86611 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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