CPT 86825 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 | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 26 - Professional component TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86825 |
National average reimbursement for CPT 86825 by major payers:
$88.77
$63.34
$107.75
$180.07
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 86825 | $48.31 | 1447317110 - BAPTIST HEALTH CARE, INC., BAPTIST HOME HEALT CARE AND MEDICAL EQUIPMENT | 590657322 - BAPTIST HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 86825 | $146.36 | 1215909320 - REBECCA GRIFFITH | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Internal Medicine Physician (207R00000X) |
United | 86825 | $115.04 | 1619910627 - BRADLEY WEISNER | 562107759 - UROLOGY SPECIALISTS OF THE CAROLINAS, PLLC | NC | Urology Physician (208800000X) |
United | 86825 | $130.07 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 86825 | $45.99 | 1144370990 - ROLANDO HENRIQUEZ | 363950044 - PROGRESSIVE MEDICAL CENTER, S.C. | IL | Internal Medicine Physician (207R00000X) |
United | 86825 | $65.69 | 1033320049 - ANN STECK | 10877201 | OH | Family Medicine Physician (207Q00000X) |
United | 86825 | $65.69 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | 86825 | $7.19 | 1174078281 - DERMATOLOGY AND SKIN CANCER SURGERY CENTER, LLC, ORLANDO DERMATOLOGY CENTER | 208048424 - (FL) DERMATOLOGY AND SKIN CANCER SURGERY CENTER LLC | FL | Dermatology Physician (207N00000X) |
United | 86825 | $144.53 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 86825 | $45.99 | 1053866707 - BRITTANY PTACHICK | 541958039 - HROA 401K PLAN | VA | Family Nurse Practitioner (363LF0000X) |
United | 86825 | $45.99 | 1053866707 - BRITTANY PTACHICK | 541958039 - HROA 401K PLAN | VA | Family Nurse Practitioner (363LF0000X) |
United | 86825 | $45.99 | 1053866707 - BRITTANY PTACHICK | 541958039 - HROA 401K PLAN | VA | Family Nurse Practitioner (363LF0000X) |
United | 86825 | $109.49 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 86825 | $65.69 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 86825 | $109.77 | 1053744888 - ASHLEY O'CONNOR | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Pediatric Nurse Practitioner (363LP0200X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 86825 vs. Other Immunology Procedures Codes
The CPT 86825 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 86825 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 |
|---|---|---|
| 86821-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. |
| 86825-CPT | Low | Blood Hla Crossmatch, Hla (Human Leukocyte Antigen) Crossmatching Is A Test Done To Ensure The Body Does Not Reject A Blood Transfusion Or Transplant. |
| 86826-CPT | Low | Hla X Match Noncytotoxc Addl, Human Leukocyte Antigen Hla Crossmatch Non Cytotoxic Eg Using Flow Cytometry Each Additional Serum Sample Or Sample Dilution List Separately In Addition To Primary Procedure |
| 86828-CPT | Low | Hla Class I Ii Antibody Qual, Antibody To Human Leukocyte Antigens Hla Solid Phase Assays Eg Microspheres Or Beads Elisa Flow Cytometry Qualitative Assessment Of The Presence Or Absence Of Antibody Ies To Hla Class I And Class Ii Hla Antigens |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86825. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86825 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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