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See a sample rate comparisonHealthcare 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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $15.84 national lab fee schedule rate (2026) · View Medicare rates for 86684 |
| Medicaid Fee Schedule | $14.57 median of the 8 states in the free preview · View Medicaid rates for 86684 |
National average reimbursement for CPT 86684 by major payers:

$14.23

$15.33

$18.15

$23.07
Choose a payer to see a sample of rates for CPT 86684.
All Ways Homecare Inc
Christopher Raio
Mercy Medical Center
Emerus Bhs Sa Thousand Oaks, LLC, Baptist Neighborhood Hospital Kelly
Emerus Bhs Sa Thousand Oaks LLC
Ann Steck
Mark Vital
Hea Clinic, P.A., Dba Houston Eye Associates
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Rate Benchmarking
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See a sample rate comparisonPayer Contract Negotiation
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See a sample payer proposalCPT 86684 vs. Other Immunology Procedures Codes
The CPT 86684 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 86684 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 |
|---|---|---|
| 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. |
| 86671-CPT | Low | Antibody Fungus Not Elsewhere Speci |
| 86677-CPT | Low | Bacteria (H. Pylori) Test, Helicobacter Pylori Can Cause Stomach Ulcers And Painful Inflammation. The Test Detects Antibodies To The Bacteria. A Positive Result Indicates Current Or Past Infection. |
| 86684-CPT | Low | Haemophilus Influenza B Test, The Test Verifies Whether A Vaccination Was Effective By Checking For Antibodies To Haemophilus Influenza B (Hib). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86684. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86684 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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