CPT 86756 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 | 11 - Office 23 - Emergency Room |
| Common Modifiers | None 26 - Professional component TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86756 |
| Medicaid Fee Schedule | View Medicaid rates for 86756 |
National average reimbursement for CPT 86756 by major payers:
$13.36
$14.23
$15.79
$22.76
CPT 86756 vs. Other Immunology Procedures Codes
The CPT 86756 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 86756 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 |
|---|---|---|
| 86735-CPT | Low | Mumps Immunity Test, This Test Measures Antibodies To The Virus That Causes Mumps. A Positive Test Indicates Current Or Past Infection Or Immunity From Vaccination. The Test Usually Is Used To Evaluate Immune Status. |
| 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. |
| 86756-CPT | Low | Virus (Rsv) Antibody Test, The Test Detects Antibodies For Respiratory Syncytial Virus (Rsv) A Lung Infection That Can Be Severe For Infants And Young Children. A Positive Result Indicates Current Or Previous Infection With Some Immunity. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86756. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86756 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 86756) and we'll show you how you compare in 15 minutes or less.