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See a sample rate comparisonCPT 86653 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.
Encephalitis Immunity Test, This Test Verifies Immunity To Or Previous Infection By Encephalitis A Bacterial Illness That Causes The Brain To Swell.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | 26 - Professional component 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $13.19 national lab fee schedule rate (2026) · View Medicare rates for 86653 |
| Medicaid Fee Schedule | $12.135 median of the 8 states in the free preview · View Medicaid rates for 86653 |
National average reimbursement for CPT 86653 by major payers:
$12.02
$13.49
$14.57
$19.61
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CPT 86653
5 of 25 sample ratesHigher to lower in this preview
Temple Vamc, Waco Vamc
$18.43Published rateThe Medical Center Of Southeast Texas Lp
$13.18Published rateOur Lady Of Lourdes Regional Medical Center,Inc
Our Lady Of Lourdes Regional Medical Center Inc
$13.18Published rateFairfield Hospital District, Freestone Medical Center
$11.21Published ratePark Place Surgery Center, LLC, Park Place Surgical Hospital
Park Place Surgical Hospital
$4.75Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86653 vs. Other Immunology Procedures Codes
The CPT 86653 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 86653 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 |
|---|---|---|
| 86651-CPT | Low | Encephalitis Immunity Test, This Test Verifies Immunity To Or Previous Infection By Encephalitis A Bacterial Illness That Causes The Brain To Swell. |
| 86652-CPT | Low | Encephalitis Immunity Test, This Test Verifies Immunity To Or Previous Infection By Encephalitis A Bacterial Illness That Causes The Brain To Swell. |
| 86653-CPT | Low | Encephalitis Immunity Test, This Test Verifies Immunity To Or Previous Infection By Encephalitis A Bacterial Illness That Causes The Brain To Swell. |
| 86654-CPT | Low | Encephalitis Immunity Test, This Test Verifies Immunity To Or Previous Infection By Encephalitis A Bacterial Illness That Causes The Brain To Swell. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86653. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86653 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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