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See a sample rate comparisonCPT 86805 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.
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.
| 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 | 91 - Repeat Lab Test 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $189.51 national lab fee schedule rate (2026) · View Medicare rates for 86805 |
| Medicaid Fee Schedule | $174.35 median of the 8 states in the free preview · View Medicaid rates for 86805 |
National average reimbursement for CPT 86805 by major payers:
$132.81
$82.07
$154.53
$261.67
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CPT 86805
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$416.92Published rateChca Mainland, L.P., Mainland Medical Center
$189.50Published ratePrisma Health-Upstate, Prisma Health Ctr For Ped & Int Med-West
Prisma Health - Upstate
$170.55Published rateChristopher Raio
Mercy Medical Center
$102.34Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$52.90Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 86805 vs. Other Immunology Procedures Codes
The CPT 86805 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 86805 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 86805. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86805 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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