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See a sample rate comparisonCPT 86769 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.
Antibody; Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]) (For Severe Acute Respiratory Syndrome Coronavirus 2 [Sars-Cov-2] [Cor
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 59 - Distinct Procedural Service 91 - Repeat Lab Test |
| Complexity Level | Low |
| Medicare Fee Schedule | $42.13 national lab fee schedule rate (2026) · View Medicare rates for 86769 |
| Medicaid Fee Schedule | $38.76 median of the 8 states in the free preview · View Medicaid rates for 86769 |
National average reimbursement for CPT 86769 by major payers:
$38.33
$27.54
$47.53
$65.88
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CPT 86769
5 of 25 sample ratesHigher to lower in this preview
Citizens Medical Center County Of Victoria, County Of Victoria Citizens Medical Center
$84.26Published rateJackson Parish Hospital, Jackson Parish Hospital
$42.13Published rateProgressive Acute Care Dauterive, LLC, Dauterive Hospital
Progressive Acute Care Dauterive LLC
$42.13Published rateEl Campo Memorial Hospital
$17.69Published rateBsa Hospital LLC
$17.69Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86769 vs. Other Immunology Procedures Codes
The CPT 86769 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 86769 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. |
| 86769-CPT | Low | Antibody; Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]) (For Severe Acute Respiratory Syndrome Coronavirus 2 [Sars-Cov-2] [Cor |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86769. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86769 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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