CPT 86759 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 | Qualitative or Semiquantitative Immunoassays Immunology Procedures |
| Common Place of Service | 23 - Emergency Room 81 - Independent Laboratory |
| Common Modifiers | None 26 - Professional component TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86759 |
National average reimbursement for CPT 86759 by major payers:
$15.02
$15.20
$17.80
$26.63
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 86759 | $18.22 | 1821026816 - EAST COOPER COMMUNITY HOSPITAL, INC., EAST COOPER MEDICAL CENTER | 934555562 | SC | General Acute Care Hospital (282N00000X) |
United | 86759 | $18.07 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 86759 | $10.94 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 86759 | $16.40 | 1942756051 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH INT MED/SUBSPEC CLINIC | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 86759 | $21.87 | 1275581852 - ROLLING PLAINS MEMORIAL HOSPITAL | 756003896 - (TX) THE NOLAN COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 86759 | $16.40 | 1720747496 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH TRANSPLANT CENTER | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 86759 | $18.07 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 86759 | $18.23 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 86759 | $18.07 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 86759 | $16.40 | 1851847974 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CANCER INST-EASLEY | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 86759 | $16.40 | 1902352008 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CANCER INST-SPARTANBURG | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 86759 | $18.22 | 1215969787 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE SIERRA CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 86759 | $9.84 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 86759 | $9.84 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 86759 | $6.38 | 1598375651 - E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC, E AND A HEALTHCARE ON THE GO | 832289173 - (FL) E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC | FL | Home Health Agency (251E00000X) |
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 86759 vs. Other Immunology Procedures Codes
The CPT 86759 code is part of the Qualitative or Semiquantitative Immunoassays 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 86759 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 |
|---|---|---|
| 86757-CPT | Low | Rickettsia Antibody Test, The Test Detects Antibodies To Rickettsia A Bacteria That Can Cause Illnesses Such As Rocky Mountain Spotted Fever Or Typhus. A Positive Result Indicates A Current Or Past Infection. |
| 86759-CPT | Low | Rotavirus Antibody Test, The Test Detects Antibodies To The Rotavirus. Presence Of Antibodies Indicates A Past Or Current Infection. |
| 86762-CPT | Low | German Measles Test, The Test Detects Antibodies To The Rubella Virus That Causes German Measles. A Positive Test Indicates Either A Current Infection Or Immunity From A Vaccine. The Test Is Used To Evaluate Immune Status. |
| 86765-CPT | Low | Measles Immunity Test, The Test Measures Antibodies To The Rubeola Virus (Measles). A Positive Test Indicates Current Or Past Infection Or Immunity From Vaccination. The Test Most Often Evaluates Immune Status. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86759. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86759 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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