Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 86612 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.
Fungal Infection Test, The Test Checks For Antibodies To The Blastomyces Fungus. Positive Results Indicate Current Or Past Infection.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $12.90 national lab fee schedule rate (2026) · View Medicare rates for 86612 |
| Medicaid Fee Schedule | $11.87 median of the 8 states in the free preview · View Medicaid rates for 86612 |
National average reimbursement for CPT 86612 by major payers:
$11.48
$13.27
$14.77
$19.19
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 86612.
CPT 86612
5 of 25 sample ratesHigher to lower in this preview
All Ways Homecare Inc
$40.00Published rateChristopher Raio
St Joseph Hospital
$15.33Published rateEast Cooper Community Hospital, Inc., East Cooper Medical Center
$12.89Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$7.97Published rateSt Davids Healthcare Partnership Lp LLP, Round Rock Medical Center
Lone Star Circle Of Care
$5.42Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 86612 vs. Other Immunology Procedures Codes
The CPT 86612 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 86612 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 |
| 86612-CPT | Low | Fungal Infection Test, The Test Checks For Antibodies To The Blastomyces Fungus. Positive Results Indicate Current Or Past Infection. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86612. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86612 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 86612) and we'll show you how you compare in 15 minutes or less.