CPT 86828 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 • 59 - Distinct Procedural Service • XU - Unusual Non-Overlapping Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86828 |
National average reimbursement for CPT 86828 by major payers:
$51.43
$35.59
$60.91
$116.44
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 86828 | ||||||
United | 86828 | $34.66 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 86828 | $34.66 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 86828 | $64.19 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 86828 | $21.76 | 1366400376 - SUNRISE HOME HEALTH CARE INC. | 650307774 - (FL) SUNRISE HOME HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 86828 | $26.96 | 1073515912 - MARK VITAL | 760512625 - HEA CLINIC, P.A., DBA HOUSTON EYE ASSOCIATES | TX | Ophthalmology Physician (207W00000X) |
United | 86828 | $65.47 | 1285669036 - ROBERT RUBINO | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Obstetrics & Gynecology Physician (207V00000X) |
United | 86828 | $22.46 | 1598375651 - E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC, E AND A HEALTHCARE ON THE GO | 832289173 - (FL) E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC | FL | Home Health Agency (251E00000X) |
United | 86828 | $85.80 | 1063491629 - JOSELYN GONZALEZ | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Internal Medicine Physician (207R00000X) |
United | 86828 | $26.95 | 1285961789 - DAYAN GANDHI | 953841576 - (CA) RENAL CONSULTANTS MEDICAL GROUP | CA | Nephrology Physician (207RN0300X) |
United | 86828 | $54.24 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 86828 | $22.85 | 1730106824 - NEVADA EYE CARE PROFESSIONALS LITTLE & STEIN, LTD. | 880316581 - NEVADA EYE CARE PROFESSIONALS | NV | Ophthalmology Physician (207W00000X) |
United | 86828 | $65.47 | 1053744888 - ASHLEY O'CONNOR | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Pediatric Nurse Practitioner (363LP0200X) |
United | 86828 | $40.04 | 1013915149 - BAYCARE HOME CARE, INC., DBA SARASOTA MEMORIAL HOME CARE | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 86828 | $22.85 | 1730106824 - NEVADA EYE CARE PROFESSIONALS LITTLE & STEIN, LTD. | 880316581 - NEVADA EYE CARE PROFESSIONALS | NV | Single Specialty Group (193400000X) |
United | 86828 | $54.24 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
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 86828 vs. Other Immunology Procedures Codes
The CPT 86828 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 86828 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 |
|---|---|---|
| 86825-CPT | Low | Human Leukocyte Antigen (Hla) Crossmatch Non- Cytotoxic (Eg Using Flow Cytometry); First Serum Sample Or Dilution |
| 86826-CPT | Low | 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 | 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 |
| 86829-CPT | Low | 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 Or 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 86828. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86828 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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