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See a sample rate comparisonCPT 86738 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.
Pneumonia Antibody Test, This Test Detects Antibodies To Mycoplasma Pneumoniae Bacteria Which Causes Pneumonia (Walking Pneumonia). Positive Results Indicate Current Or Past Infection.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $13.24 national lab fee schedule rate (2026) · View Medicare rates for 86738 |
| Medicaid Fee Schedule | $12.18 median of the 8 states in the free preview · View Medicaid rates for 86738 |
National average reimbursement for CPT 86738 by major payers:
$11.80
$13.66
$14.80
$19.69
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CPT 86738
5 of 25 sample ratesHigher to lower in this preview
Citizens Medical Center County Of Victoria, County Of Victoria Citizens Medical Center
$26.47Published rateSt Davids Healthcare Partnership Lp LLP, Round Rock Medical Center
$13.23Published rateMethodist Hospitals Of Dallas, Methodist Mansfield Medical Center
Methodist Hospitals Of Dallas
$13.23Published rateParish Hospital Service District For The Parish Of Orleans, New Orleans East Hospital
$11.92Published rateSerge Lartchenko M.D., PLLC
Serge Lartchenko Md PLLC
$7.57Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86738 vs. Other Immunology Procedures Codes
The CPT 86738 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 86738 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 |
|---|---|---|
| 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. |
| 86727-CPT | Low | Virus Antibody Blood Test, The Test Detects Antibodies To The Lymphocytic Choriomeningitis Virus Which Is Carried By Rodents. The Presence Of Antibodies In The Blood Indicates Past Or Current Infection. |
| 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 86738. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86738 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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