CPT 86720 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 | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | None 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86720 |
| Medicaid Fee Schedule | View Medicaid rates for 86720 |
National average reimbursement for CPT 86720 by major payers:
$13.37
$14.29
$17.19
$23.53
CPT 86720 vs. Other Immunology Procedures Codes
The CPT 86720 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 86720 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 |
|---|---|---|
| 86717-CPT | Low | Leishmania Antibody Test, The Test Checks For Antibodies To The Parasite Group Leishmania Which Cause Intestinal Upset. Antibodies Indicate A Past Or Current Infection. |
| 86720-CPT | Low | Bacteria Immunity Test, This Test Verifies Exposure To Leptospira Bacteria Which Are Transmitted By Animals. If Antibodies Are Present Immunity Is Likely. |
| 86723-CPT | Low | Food Poisoning Immune Test, The Test Checks For Antibodies To Listeria Monocytogenes A Bacteria Commonly Responsible For Food Poisoning. |
| 86738-CPT | Low | Pneumonia Antibody Test, This Test Detects Antibodies To Mycoplasma Pneumoniae Bacteria Which Causes Pneumonia (Walking Pneumonia). Positive Results Indicate Current Or Past Infection. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86720. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86720 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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