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See a sample rate comparisonCPT 86631 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.
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.
| 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 | $11.82 national lab fee schedule rate (2026) · View Medicare rates for 86631 |
| Medicaid Fee Schedule | $11.02 median of the 8 states in the free preview · View Medicaid rates for 86631 |
National average reimbursement for CPT 86631 by major payers:
$10.67
$12.54
$13.12
$17.36
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CPT 86631
5 of 25 sample ratesHigher to lower in this preview
Restorative Health Rehabilitation Inc
$40.00Published rateChristopher Raio
St Joseph Hospital
$14.04Published ratePrisma Health-Upstate, Prisma Health Center For Pediatric Med
Prisma Health - Upstate
$10.64Published ratePrisma Health-Upstate, Prisma Health Hillcrest Hospital Vascular Lab
Prisma Health - Upstate
$10.64Published rateChristopher Raio
Mercy Medical Center
$6.38Published rate
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See a sample payer proposalCPT 86631 vs. Other Immunology Procedures Codes
The CPT 86631 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 86631 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 |
|---|---|---|
| 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. |
| 86632-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. |
| 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 86631. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86631 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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