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See a sample rate comparisonCPT 86803 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.
Hepatitis C Antibody Test, This Blood Test Detects Antibodies For Hepatitis (Hep) C A Virus That Can Damage The Liver. If The Result Is Positive There Is A Current Or Previous Infection.
| 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 | $14.27 national lab fee schedule rate (2026) · View Medicare rates for 86803 |
| Medicaid Fee Schedule | $14.09 median of the 8 states in the free preview · View Medicaid rates for 86803 |
National average reimbursement for CPT 86803 by major payers:
$12.84
$10.09
$17.71
$21.08
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CPT 86803
5 of 25 sample ratesHigher to lower in this preview
Kenneth Hung
Yale University
$31.70Published rateAlex Sherman
Vanguard Gastroenterology LLP
$19.88Published rateCalley Levine
North Shore-Lij Medical PC
$15.06Published rateCarson Medical Group Professional Corporation
Carson Medical Group
$8.37Published rateIgal Khorshidi
Igal Khorshidi M.D., P.C.
$5.98Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86803 vs. Other Immunology Procedures Codes
The CPT 86803 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 86803 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 |
|---|---|---|
| 86800-CPT | Low | Thyroid Autoimmune Test, The Test Looks For Thyroglobulin Antibodies. These Immune Proteins Can Be Present With Autoimmune Diseases. This Test Evaluates Abnormal Results From Previous Thyroid Gland Tests. |
| 86803-CPT | Low | Hepatitis C Antibody Test, This Blood Test Detects Antibodies For Hepatitis (Hep) C A Virus That Can Damage The Liver. If The Result Is Positive There Is A Current Or Previous Infection. |
| 86804-CPT | Low | Hepatitis C Antibody Test, This Blood Test Detects Antibodies For Hepatitis (Hep) C A Virus That Can Damage The Liver. If The Result Is Positive There Is A Current Or Previous Infection. |
| 86805-CPT | Low | Test For Donor Match, This Test Verifies Whether Donor And Recipient Tissues Are Compatible. Samples From Each Are Combined And Then Watched To See If There Are Toxic Reactions Such As Cell Death. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86803. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86803 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 out the cost of a medical procedure for your specific situation, you'll typically need to know the CPT (Current Procedural Terminology) code for the service and your geographic location. Healthcare costs can vary significantly based on the provider, your insurance plan, and your location. For a precise fee schedule lookup tool that allows you to search with a CPT code and specific location, you should use Payerprice. Payerprice offers a tool to help users understand costs specific to their area and the services they need.
A CPT (Current Procedural Terminology) code is a five-digit numerical code used by healthcare providers, payers, and facilities to describe medical, surgical, and diagnostic services. CPT codes are crucial because they standardize the reporting of medical procedures and services, which directly impacts how services are billed and reimbursed. When looking up healthcare costs, knowing the specific CPT code allows you to get more accurate pricing information for that particular service.
CMS (Centers for Medicare & Medicaid Services) is a federal agency that administers Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). While CMS publishes a lot of data, including Medicare fee schedules and general healthcare statistics, it primarily focuses on federal programs and regulatory guidelines. For looking up specific fee schedules based on CPT codes and your specific location for all payers (not just Medicare/Medicaid), Payerprice offers a dedicated fee schedule lookup tool. Payerprice is designed to provide users with more granular and personalized pricing information beyond general CMS data.
Location significantly impacts medical procedure costs due to several factors. These include variations in the cost of living and operating expenses for healthcare facilities, regional supply and demand for specific services, local market competition among providers, and differences in state regulations or insurance contract negotiations. For instance, a procedure performed in a major metropolitan area might cost more than the same procedure in a rural area. Tools like Payerprice are designed to account for these geographical variations by allowing you to search for fee schedules based on your specific location.