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See a sample rate comparisonCPT 86794 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.
Zika Virus Antibody Blood Test, The Test Detects Antibodies To Zika Virus. The Presence Of Antibodies In The Blood Indicates Past Or Present Infection.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $16.85 national lab fee schedule rate (2026) · View Medicare rates for 86794 |
| Medicaid Fee Schedule | $16.68 median of the 8 states in the free preview · View Medicaid rates for 86794 |
National average reimbursement for CPT 86794 by major payers:
$14.36
$11.16
$18.73
$45.65
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CPT 86794
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$37.07Published rateMaricopa County Special Health Care District, Valleywise Health
$20.21Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$16.85Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$15.34Published rateBrittany Ptachick
Hroa 401k Plan
$7.08Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86794 vs. Other Immunology Procedures Codes
The CPT 86794 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 86794 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 |
|---|---|---|
| 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. |
| 86790-CPT | Low | Virus Antibody Test, This Test Detects Antibodies Made In Response To Specific Viruses. Positive Results Indicate Current Or Past Infection. |
| 86794-CPT | Low | Zika Virus Antibody Blood Test, The Test Detects Antibodies To Zika Virus. 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 86794. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86794 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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