CPT 86753 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 11 - Office |
| Common Modifiers | None 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86753 |
| Medicaid Fee Schedule | View Medicaid rates for 86753 |
National average reimbursement for CPT 86753 by major payers:
$10.75
$14.09
$13.98
$18.32
CPT 86753 vs. Other Immunology Procedures Codes
The CPT 86753 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 86753 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 |
|---|---|---|
| 86744-CPT | Low | Nocardia Bacteria Immune Test, The Test Identifies Antibodies To Nocardia Bacteria Which Creates Open Sores Or Lung Infections. Generally The Bacteria Infect Immune-Compromised People. |
| 86747-CPT | Low | Parvovirus B19 Test, This Blood Test Detects Antibodies To Parvovirus B19 Which Causes Fifth Disease. This Virus Is Most Common In Children And Causes A Characteristic Rash. Adults May Have Joint Pain And Swelling. |
| 86750-CPT | Low | Malaria Antibody Test, This Test Detects Antibodies To Plasmodium The Bacteria That Causes Malaria. The Presence Of Antibodies Indicates Immunity From A Vaccine Or A Past Infection. |
| 86753-CPT | Low | Protozoa Antibody Test, This Blood Test Measures The Antibody Response To Certain Protozoa (Single-Cell Organisms) That Can Cause Diseases. The Result Can Indicate A 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 86753. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86753 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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