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See a sample rate comparisonCPT 86780 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.
Syphilis Testing, This Test Detects Antibodies To Syphilis A Bacterial Infection. It Is Frequently Spread By Sexual Contact. Blood Tests Screen For The Infection And Monitor Response To Treatment.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $13.24 national lab fee schedule rate (2026) · View Medicare rates for 86780 |
| Medicaid Fee Schedule | $13.075 median of the 8 states in the free preview · View Medicaid rates for 86780 |
National average reimbursement for CPT 86780 by major payers:
$11.76
$9.29
$15.46
$44.17
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CPT 86780
5 of 25 sample ratesHigher to lower in this preview
St. Luke'S Community Health Services, St. Luke'S The Woodlands Hospital
St Lukes Community Health Services
$24.51Published rateTenet Hospitals Limited, The Hospitals Of Providence Memorial Campus
$13.23Published rateMethodist Hospitals Of Dallas, Methodist Richardson Medical Center
Methodist Hospitals Of Dallas
$13.23Published rateSt. Tammany Parish Hospital Service District No 1, St. Tammany Parish Hospital
$11.92Published rateAscension Seton, Ascension Seton Medical Center Austin
Ascension Seton
$5.03Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86780 vs. Other Immunology Procedures Codes
The CPT 86780 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 86780 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 |
|---|---|---|
| 86774-CPT | Low | Tetanus Immunity Test, This Test Is Used Primarily To Determine Immune Status To Tetanus. It Is Rarely Used To Diagnose An Infection. |
| 86777-CPT | Low | Toxoplasma Antibody Test, Toxoplasmosis Is An Illness Carried By A Parasite That Can Cause Complications With A Pregnancy. Immune-Compromised People Also Are At Risk. Testing Checks Spinal Fluid Blood Or Amniotic Fluid. The Result Shows A Current Or Past Infection Or Immunity. |
| 86778-CPT | Low | Toxoplasma Antibody Test, Toxoplasmosis Is An Illness Carried By A Parasite That Can Cause Complications With A Pregnancy. Immune-Compromised People Also Are At Risk. Testing Checks Spinal Fluid Blood Or Amniotic Fluid. The Result Shows A Current Or Past Infection Or Immunity. |
| 86780-CPT | Low | Syphilis Testing, This Test Detects Antibodies To Syphilis A Bacterial Infection. It Is Frequently Spread By Sexual Contact. Blood Tests Screen For The Infection And Monitor Response To Treatment. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86780. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86780 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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Frequently Asked Questions
To find the estimated cost of a specific medical procedure or service, you can utilize price transparency tools. For personalized information based on a CPT code and your specific location, Payerprice offers a fee schedule lookup tool. This can help you understand potential costs before receiving care.
CPT stands for Current Procedural Terminology. These are standardized codes used by healthcare professionals to describe medical, surgical, and diagnostic services to payers for reimbursement. CPT codes are crucial for understanding medical costs because they precisely identify the service performed, allowing for accurate pricing and comparison across different providers and locations.
Information about typical medical fees can be found through various resources. For specific fee schedule data tailored to CPT codes and your exact location, Payerprice provides a comprehensive lookup tool. This allows you to research the usual costs associated with particular medical services.
If your medical bill seems unusually high, the first step is to contact your healthcare provider's billing department to request an itemized bill and clarify any charges. You should also review your Explanation of Benefits (EOB) from your insurance company to ensure accuracy. To compare the charges against typical costs for your specific CPT codes and location, you can use a tool like Payerprice to get a better understanding of reasonable pricing.
Yes, insurance significantly affects the amount you pay for a medical service. Your insurance plan negotiates discounted rates with providers, and you are typically responsible for your deductible, copayments, and coinsurance amounts based on these negotiated rates. The 'cost' of a service can refer to the billed amount, the allowed amount by insurance, or your out-of-pocket responsibility. Always check with your insurance provider about your specific benefits and coverage before receiving services.