Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 86790 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.
Virus Antibody Test, This Test Detects Antibodies Made In Response To Specific Viruses. Positive Results Indicate Current Or Past Infection.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $12.88 national lab fee schedule rate (2026) · View Medicare rates for 86790 |
| Medicaid Fee Schedule | $11.85 median of the 8 states in the free preview · View Medicaid rates for 86790 |
National average reimbursement for CPT 86790 by major payers:
$11.55
$13.28
$15.36
$19.06
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 86790.
CPT 86790
5 of 25 sample ratesHigher to lower in this preview
Randall Johnson
Neuroscience Group Of Northeast Wisconsin, S.C.
$31.72Published rateJaime Velie
Neuroscience Group Of Northeast Wisconsin, S.C.
$31.72Published ratePrisma Health-Upstate
Prisma Health - Upstate
$11.59Published rateBrenna Williams
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$6.57Published rateMaritza Klaiber
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$6.57Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 86790 vs. Other Immunology Procedures Codes
The CPT 86790 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 86790 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 |
|---|---|---|
| 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. |
| 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. |
| 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. |
| 86790-CPT | Low | Virus Antibody Test, This Test Detects Antibodies Made In Response To Specific Viruses. Positive Results Indicate Current Or Past Infection. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86790. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86790 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 86790) and we'll show you how you compare in 15 minutes or less.