CPT 86831 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 81 - Independent Laboratory |
| Common Modifiers | None PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86831 |
| Medicaid Fee Schedule | View Medicaid rates for 86831 |
National average reimbursement for CPT 86831 by major payers:
$68.53
$52.98
$81.41
$135.45
CPT 86831 vs. Other Immunology Procedures Codes
The CPT 86831 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 86831 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 |
|---|---|---|
| 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 |
| 86829-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 Or Class Ii Hla Antigens |
| 86831-CPT | Low | Hla Class Ii Phenotype Qual, Antibody To Human Leukocyte Antigens Hla Solid Phase Assays Eg Microspheres Or Beads Elisa Flow Cytometry Antibody Identification By Qualitative Panel Using Complete Hla Phenotypes Hla Class Ii |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86831. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86831 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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