CPT 86765 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 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86765 |
| Medicaid Fee Schedule | View Medicaid rates for 86765 |
National average reimbursement for CPT 86765 by major payers:
$11.49
$10.55
$15.12
$18.92
CPT 86765 vs. Other Immunology Procedures Codes
The CPT 86765 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 86765 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 |
|---|---|---|
| 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. |
| 86768-CPT | Low | Salmonella Antibody Test, The Test Detects Antibodies To Salmonella Bacteria. Presence Of Antibodies Indicates A Past Or Current Infection. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86765. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86765 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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