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See a sample rate comparisonCPT 86648 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.
Diphtheria Immunity Test, This Test Detects Antibodies To Diphtheria Bacteria. A Positive Result Indicates Exposure Or Immunity From A Vaccine. Children And Adults Are Routinely Vaccinated For This Illness.
| 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 PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
| Medicare Fee Schedule | $15.21 national lab fee schedule rate (2026) · View Medicare rates for 86648 |
| Medicaid Fee Schedule | $13.995 median of the 8 states in the free preview · View Medicaid rates for 86648 |
National average reimbursement for CPT 86648 by major payers:
$13.65
$14.80
$16.86
$21.99
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CPT 86648
5 of 25 sample ratesHigher to lower in this preview
Restorative Health Rehabilitation Inc
$60.00Published rateChristopher Raio
Mercy Medical Center
$20.08Published rateProgressive Acute Care Avoyelles, LLC, Avoyelles Hospital
$13.68Published ratePrisma Health-Upstate, Prisma Health Cancer Inst-Greer
Prisma Health - Upstate
$13.68Published rateBsa Hospital LLC
$6.38Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86648 vs. Other Immunology Procedures Codes
The CPT 86648 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 86648 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 |
|---|---|---|
| 86648-CPT | Low | Diphtheria Immunity Test, This Test Detects Antibodies To Diphtheria Bacteria. A Positive Result Indicates Exposure Or Immunity From A Vaccine. Children And Adults Are Routinely Vaccinated For This Illness. |
| 86658-CPT | Low | Virus Antibody Blood Test, The Test Detects Antibodies To The Enterovirus Group. The Presence Of Antibodies In The Blood Indicates Past Or Current Infection. |
| 86663-CPT | Low | Mononucleosis Test, This Test Detects Current Or Prior Infection With The Epstein-Barr Virus Which Causes Infectious Mononucleosis And Is Associated With Certain Cancers. |
| 86664-CPT | Low | Mononucleosis Test, This Test Detects Current Or Prior Infection With The Epstein-Barr Virus Which Causes Infectious Mononucleosis And Is Associated With Certain Cancers. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86648. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86648 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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