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See a sample rate comparisonCPT 86695 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.
Herpes Simplex Virus 1 Test, This Test For Antibodies To The Herpes Simplex Virus Confirms Past Or Current Infection With Type 1.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $13.19 national lab fee schedule rate (2026) · View Medicare rates for 86695 |
| Medicaid Fee Schedule | $12.135 median of the 8 states in the free preview · View Medicaid rates for 86695 |
National average reimbursement for CPT 86695 by major payers:
$11.62
$13.60
$15.30
$19.32
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CPT 86695
5 of 25 sample ratesHigher to lower in this preview
Christopher Raio
St Francis Hospital
$18.07Published rateAthens Hospital, LLC
$13.18Published ratePrisma Health-Upstate, Prisma Health Center For Pediatric Med
Prisma Health - Upstate
$11.86Published rateRolling Plains Memorial Hospital
The Nolan County Hospital District
$7.73Published rateSt Davids Healthcare Partnership Lp LLP, Round Rock Medical Center
Lone Star Circle Of Care
$5.53Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86695 vs. Other Immunology Procedures Codes
The CPT 86695 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 86695 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 |
|---|---|---|
| 86694-CPT | Low | Test For Herpes Simplex Virus, There Are Three Tests For Antibodies To The Herpes Simplex Virus. The General Test Confirms A Current Or Past Infection And Is Not Type-Specific. The Other Two Tests Verify Past Or Current Infection With Type 1 Or Type 2. |
| 86695-CPT | Low | Herpes Simplex Virus 1 Test, This Test For Antibodies To The Herpes Simplex Virus Confirms Past Or Current Infection With Type 1. |
| 86696-CPT | Low | Test For Herpes Simplex Virus, There Are Three Tests For Antibodies To The Herpes Simplex Virus. The General Test Confirms A Current Or Past Infection And Is Not Type-Specific. The Other Two Tests Verify Past Or Current Infection With Type 1 Or Type 2. |
| 86713-CPT | Low | Legionnaires Disease Test, This Test Detects Infection With Legionella A Gram Negative Bacteria Responsible For Legionnaires Disease. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86695. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86695 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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