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See a sample rate comparisonCPT 86658 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.
Virus Antibody Blood Test, The Test Detects Antibodies To The Enterovirus Group. The Presence Of Antibodies In The Blood Indicates Past Or Current Infection.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | 90 - Reference Laboratory 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $13.03 national lab fee schedule rate (2026) · View Medicare rates for 86658 |
| Medicaid Fee Schedule | $11.985 median of the 8 states in the free preview · View Medicaid rates for 86658 |
National average reimbursement for CPT 86658 by major payers:
$11.67
$13.33
$13.80
$19.08
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CPT 86658
5 of 25 sample ratesHigher to lower in this preview
Temple Vamc, Waco Vamc
$18.20Published rateSpartanburg Medical Center
$15.64Published rateTenet Hospitals Limited, The Hospitals Of Providence Sierra Campus
$13.02Published rateThe Good Shepherd Hospital, Inc., Christus Good Shepherd Medical Center - Longview
Good Shepherd Hospital Inc
$7.75Published rateSt. Davids Healthcare Partnership, L.P., LLP, Heart Hospital Of Austin
Lone Star Circle Of Care
$5.46Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86658 vs. Other Immunology Procedures Codes
The CPT 86658 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 86658 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. |
| 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. |
| 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. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86658. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86658 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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