CPT 86689 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | None 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86689 |
| Medicaid Fee Schedule | View Medicaid rates for 86689 |
National average reimbursement for CPT 86689 by major payers:
$17.35
$14.13
$22.36
$28.91
CPT 86689 vs. Other Immunology Procedures Codes
The CPT 86689 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 86689 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 |
|---|---|---|
| 86687-CPT | Low | Test For T-Cell Leukemia, This Blood Test Detects Infection With Human T-Cell Leukemia I Virus. It Also Is Used To Screen Blood And Blood Products Prior To Transfusion. |
| 86688-CPT | Low | Test For T-Cell Leukemia, This Blood Test Detects Infection With Human T-Cell Leukemia Ii Virus. It Also Is Used To Screen Blood And Blood Products Prior To Transfusion. |
| 86689-CPT | Low | Test To Confirm Hiv/Leukemia, This Test Is Used As A Confirmation Test When Initial Test Results Are Positive Or Inconclusive. The Test Verifies Either Human T-Cell Leukemia Ii Virus Or Hiv. |
| 86701-CPT | Low | Hiv Screening Test, This Test Detects Antibodies To Hiv (Aids Virus) Type 1 Type 2 Or Both. It Is Used To Screen For Hiv Infection. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86689. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86689 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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