CPT 86813 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86813 |
| Medicaid Fee Schedule | View Medicaid rates for 86813 |
National average reimbursement for CPT 86813 by major payers:
$50.89
$41.45
$61.49
$84.16
CPT 86813 vs. Other Immunology Procedures Codes
The CPT 86813 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 86813 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 86813. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86813 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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