CPT 86618 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 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86618 |
| Medicaid Fee Schedule | View Medicaid rates for 86618 |
National average reimbursement for CPT 86618 by major payers:
$15.59
$13.32
$19.98
$24.84
CPT 86618 vs. Other Immunology Procedures Codes
The CPT 86618 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 86618 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 |
|---|---|---|
| 86617-CPT | Low | Test For Lyme Disease, Lyme Disease Is Caused By Borrelia Burgdorferi And This Test Detects Antibodies Produced In Response. A Follow-Up Test Confirms A Positive Result. The Test Sample May Be Spinal Fluid Blood Or Urine. |
| 86618-CPT | Low | Test For Lyme Disease, Lyme Disease Is Caused By Borrelia Burgdorferi And This Test Detects Antibodies Produced In Response. A Follow-Up Test Confirms A Positive Result. The Test Sample May Be Spinal Fluid Blood Or Urine. |
| 86619-CPT | Low | Relapsing Fever Test, The Test Detects Antibodies To Borrelia Bacteria Which Cause Relapsing Fever. The Presence Of Antibodies Suggests A Past Or Current Infection. |
| 86638-CPT | Low | Q Fever Antibody Test, Q Fever Is Caused By Coxiella Burnetii Bacteria. The Test Checks For Antibodies Which Can Indicate A Past Or Current Infection. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86618. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86618 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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