CPT 86789 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 21 - Inpatient Hospital |
| Common Modifiers | None 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86789 |
| Medicaid Fee Schedule | View Medicaid rates for 86789 |
National average reimbursement for CPT 86789 by major payers:
$12.91
$10.10
$15.83
$49.09
CPT 86789 vs. Other Immunology Procedures Codes
The CPT 86789 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 86789 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 |
|---|---|---|
| 86787-CPT | Low | Chickenpox Immunity Test, This Blood Test Measures Immunity To The Varicella-Zoster Virus Which Causes Both Chickenpox And Shingles. A Positive Result Indicates A Prior Infection Or Immunity Resulting From Vaccination. |
| 86788-CPT | Low | Test For West Nile Virus, The Test Detects Antibodies To West Nile Virus. The Presence Of Antibodies In A Blood Sample Indicates Past Or Present Infection Or Immunity From A Vaccine. |
| 86789-CPT | Low | Test For West Nile Virus, The Test Detects Antibodies To West Nile Virus. The Presence Of Antibodies In A Blood Sample Indicates Past Or Present Infection Or Immunity From A Vaccine. |
| 86793-CPT | Low | Yersinia Antibody Blood Test, The Test Detects Antibodies To Yersinia Bacteria A Gram-Negative Bacteria That Causes Various Intestinal Illnesses. The Presence Of Antibodies In The Blood Indicates Past Or Present Infection. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86789. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86789 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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