CPT 86713 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 | 21 - Inpatient Hospital 81 - Independent Laboratory |
| Common Modifiers | None 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86713 |
National average reimbursement for CPT 86713 by major payers:
$13.94
$15.04
$17.78
$23.08
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 86713 | $8.97 | 1447259627 - TYLER COUNTY HOSPITAL DISTRICT | 746067306 | TX | General Acute Care Hospital (282N00000X) |
United | 86713 | $18.18 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 86713 | $15.30 | 1821026816 - EAST COOPER COMMUNITY HOSPITAL, INC., EAST COOPER MEDICAL CENTER | 934555562 | SC | General Acute Care Hospital (282N00000X) |
United | 86713 | $60.00 | 1801164967 - DA PEDIATRIC REHABILITATION | 270939565 - (FL) DA PEDIATRIC REHABILITATION | FL | Home Health Agency (251E00000X) |
United | 86713 | $29.15 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 86713 | $18.79 | 1104819366 - CHILDREN'S HOSPITAL | 720467503 - CHILDRENS HOSPITAL INC | LA | Children's Hospital (282NC2000X) |
United | 86713 | $20.20 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 86713 | $9.21 | 1760429831 - BRUCE MADSEN | 260210091 - (OR) BRIDGEPORT EYE PHYSICIANS LLC | OR | Ophthalmology Physician (207W00000X) |
United | 86713 | $15.30 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 86713 | $8.76 | 1366428401 - AARON ASKEW | 911750212 - DESERT BONE & JOINT SPECIALISTS, LLP | OR | Orthopaedic Trauma Physician (207XX0801X) |
United | 86713 | $33.66 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 86713 | $15.30 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 86713 | $33.66 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 86713 | $15.30 | 1003811290 - PROVIDENCE HOSPITAL, LLC, PROVIDENCE HEALTH | 571098556 - (SC) MEDICAL UNIVERSITY HOSPITAL AUTHORITY | SC | General Acute Care Hospital (282N00000X) |
United | 86713 | $18.18 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 86713 vs. Other Immunology Procedures Codes
The CPT 86713 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 86713 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 |
|---|---|---|
| 86617-CPT | Low | Test For Lyme Disease, Lyme Disease Is Caused By Borrelia Burgdorferi And This Test Detects Antibodies Produced In Response. A Follow-Up Test Confirms A Positive Result. The Test Sample May Be Spinal Fluid Blood Or Urine. |
| 86674-CPT | Low | Parasite Immune Test (Giardia), The Test Checks For Antibodies To The Parasite Giardia Lamblia Which Causes Intestinal Distress. The Presence Of Antibodies Indicates Past Or Current Infection. |
| 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. |
| 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 86713. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86713 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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