Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 86696 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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 90 - Reference Laboratory 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $19.35 national lab fee schedule rate (2026) · View Medicare rates for 86696 |
| Medicaid Fee Schedule | $19.11 median of the 8 states in the free preview · View Medicaid rates for 86696 |
National average reimbursement for CPT 86696 by major payers:
$17.02
$14.14
$22.30
$28.03
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 86696.
CPT 86696
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$42.57Published rateThe Medical Center Of Southeast Texas Lp
$19.35Published rateSlidell Memorial Hospital, Md Imaging Slidell
Slidell Memorial Hospital
$19.35Published ratePrisma Health-Upstate, Prisma Health Int Med/Subspec Clinic
Prisma Health - Upstate
$17.42Published rateMatthew Lilley
The Orthopedic And Neurosurgical Center Of The Cascades
$8.13Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 86696 vs. Other Immunology Procedures Codes
The CPT 86696 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 86696 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 |
|---|---|---|
| 86664-CPT | Low | Mononucleosis Test, This Test Detects Current Or Prior Infection With The Epstein-Barr Virus Which Causes Infectious Mononucleosis And Is Associated With Certain Cancers. |
| 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. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86696. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86696 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 86696) and we'll show you how you compare in 15 minutes or less.