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See a sample rate comparisonCPT 86812 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.
Blood Test For Genetic Markers, This Blood Test Matches Donors And Transplant Recipients By Finding Compatible Hlas (Human Leukocyte Antigens) Which Are Proteins Found In White Blood Cells. Hla Typing May Also Be Part Of The Work Up For Some Cancers And Autoimmune Diseases.
| 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 GZ - Item or Service Expected to Be Denied as Not Reasonable and Necessary |
| Complexity Level | Low |
| Medicare Fee Schedule | $25.81 national lab fee schedule rate (2026) · View Medicare rates for 86812 |
| Medicaid Fee Schedule | $25.485 median of the 8 states in the free preview · View Medicaid rates for 86812 |
National average reimbursement for CPT 86812 by major payers:
$23.40
$18.60
$29.21
$38.31
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CPT 86812
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$56.78Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$30.66Published ratePrisma Health-Upstate, Prisma Health Hillcrest Hospital Vascular Lab
Prisma Health - Upstate
$23.22Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$14.42Published rateE And A Medical On The Go Healthcare Of South Florida LLC, E And A Healthcare On The Go
E And A Medical On The Go Healthcare Of South Florida LLC
$9.02Published rate
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See a sample payer proposalCPT 86812 vs. Other Immunology Procedures Codes
The CPT 86812 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 86812 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 |
|---|---|---|
| 86808-CPT | Low | Transplant Acceptance Test, This Test Measures The Amount Of Anti-Human Antibody In A Blood Sample. This Is A Key Test To Determine Whether A Transplant Will Be Successful. There Are Two Versions Of The Test. |
| 86812-CPT | Low | Blood Test For Genetic Markers, This Blood Test Matches Donors And Transplant Recipients By Finding Compatible Hlas (Human Leukocyte Antigens) Which Are Proteins Found In White Blood Cells. Hla Typing May Also Be Part Of The Work Up For Some Cancers And Autoimmune Diseases. |
| 86813-CPT | Low | Blood Test For Genetic Markers, This Blood Test Matches Donors And Transplant Recipients By Finding Compatible Hlas (Human Leukocyte Antigens) Which Are Proteins Found In White Blood Cells. Hla Typing May Also Be Part Of The Work Up For Some Cancers And Autoimmune Diseases. |
| 86816-CPT | Low | Blood Test For Genetic Markers, This Blood Test Matches Donors And Transplant Recipients By Finding Compatible Hlas (Human Leukocyte Antigens) Which Are Proteins Found In White Blood Cells. Hla Typing May Also Be Part Of The Work Up For Some Cancers And Autoimmune Diseases. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86812. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86812 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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