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See a sample rate comparisonCPT 86628 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.
Yeast Infection Test, Candida Is A Yeast (Fungus) That Can Cause Infection. This Test Detects Antibodies Made In Response To A Widespread Infection. Results Assess The Severity Of The Infection And Response To Therapy.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 90 - Reference Laboratory 91 - Repeat Lab Test |
| Complexity Level | Low |
| Medicare Fee Schedule | $12.01 national lab fee schedule rate (2026) · View Medicare rates for 86628 |
| Medicaid Fee Schedule | $11.20 median of the 8 states in the free preview · View Medicaid rates for 86628 |
National average reimbursement for CPT 86628 by major payers:
$10.74
$12.59
$12.94
$17.74
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CPT 86628
5 of 25 sample ratesHigher to lower in this preview
Restorative Health Rehabilitation Inc
$35.00Published ratePrisma Health-Upstate, Prisma Health Ctr For Ped & Int Med-West
Prisma Health - Upstate
$10.81Published ratePrisma Health-Upstate, Prisma Health Cancer Inst-Greer
Prisma Health - Upstate
$10.81Published rateChristopher Raio
St Joseph Hospital
$7.21Published rateE And A Medical On The Go Healthcare Of South Florida LLC, E And A Healthcare On The Go
E And A Medical On The Go Healthcare Of South Florida LLC
$4.19Published rate
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See a sample payer proposalCPT 86628 vs. Other Immunology Procedures Codes
The CPT 86628 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 86628 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 |
|---|---|---|
| 86628-CPT | Low | Yeast Infection Test, Candida Is A Yeast (Fungus) That Can Cause Infection. This Test Detects Antibodies Made In Response To A Widespread Infection. Results Assess The Severity Of The Infection And Response To Therapy. |
| 86631-CPT | Low | Chlamydia Infection Evaluation, This Blood Test Evaluates The Likelihood Of Previous Or Current Exposure To Chlamydia. Chlamydia Are Bacteria That Can Cause Infections Of The Eyes Urinary Tract And Lungs. |
| 86635-CPT | Low | Valley Fever Antibody Test, Valley Fever Is Caused By The Fungus Coccidioides Immitis Which Is Common In Desert Areas. This Blood Test Detects Antibodies That Indicate A Current Or Past Infection. |
| 86644-CPT | Low | Cytomegalovirus (Cmv) Test, The Test Checks For Antibody Response To Cytomegalovirus (Cmv). Results Can Indicate Either Current Or Previous Cmv Infection. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86628. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86628 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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