How much does Medicare pay for CPT 86038?

Medicare allowed an average of $11.83 per service and paid $11.83 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $81.74, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86038?

Screening test for autoimmune disorder. It was billed 675,540 times to 611,783 Medicare beneficiaries by 811 providers in 2024.

Which specialty bills 86038 most?

Clinical Laboratory, with 645,719 services from 333 clinicians. Next are Rheumatology, Pathology, Internal Medicine.

CPT 86038

Screening test for autoimmune disorder

$11.83Medicare-allowed amount per service, averaged across 675,540 services

Providers submitted

$81.74

Asking price, not received

Medicare allowed

$11.83

The fee schedule figure

Medicare paid

$11.83

Balance is patient coinsurance

Providers submitted an average of $81.74 for this code and Medicare allowed $11.83 — 6.9× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $11.83 (100%); the rest is the patient’s coinsurance and deductible.

Services: 675,540
Beneficiaries: 611,783
Providers billing it: 811
Total allowed: $7,991,638

What Medicare pays for CPT 86038

Across 675,540 services billed by 811 providers to 611,783 beneficiaries, Medicare allowed an average of $11.83 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 86038

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	645,719	586,267	$11.84	333
Rheumatology	18,220	14,803	$11.77	238
Pathology	4,120	3,859	$11.76	10
Internal Medicine	2,395	1,892	$11.80	57
Hematology-Oncology	1,245	1,214	$11.83	41
Nurse Practitioner	1,016	974	$11.78	33
Family Practice	931	914	$11.75	35
Physician Assistant	610	608	$11.79	19
Neurology	300	300	$11.85	10
Nephrology	211	210	$11.85	7
Medical Oncology	199	185	$11.79	7
Hospitalist	147	140	$11.78	2
Pulmonary Disease	145	143	$11.81	4
Emergency Medicine	57	57	$11.85	1
Pediatric Medicine	41	41	$11.85	2

86038 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	121,547	$11.84	$11.85	77
New Jersey	99,159	$11.84	$11.85	29
Texas	67,566	$11.83	$11.85	55
Florida	64,562	$11.84	$11.85	51
North Carolina	60,107	$11.84	$11.85	28
New York	31,170	$11.84	$11.85	92
Arizona	28,341	$11.82	$11.85	24
Georgia	24,206	$11.85	$11.85	16
Ohio	22,270	$11.83	$11.85	25
Alabama	19,105	$11.83	$11.85	16
Illinois	16,444	$11.84	$11.85	41
Kansas	15,535	$11.84	$11.85	14
Tennessee	15,271	$11.81	$11.85	22
Massachusetts	12,594	$11.85	$11.85	17
Pennsylvania	9,967	$11.84	$11.85	16
Washington	7,772	$11.84	$11.85	9
Maryland	7,742	$11.83	$11.85	37
Oklahoma	7,535	$11.81	$11.85	28
Nevada	5,633	$11.83	$11.85	3
Wisconsin	4,524	$11.67	$11.85	14
Virginia	4,146	$11.79	$11.85	7
Hawaii	3,975	$11.81	$11.85	2
Colorado	3,459	$11.82	$11.85	9
Minnesota	3,130	$11.81	$11.85	21
Michigan	3,110	$11.81	$11.85	13
Oregon	2,547	$11.79	$11.85	8
New Mexico	2,046	$11.76	$11.85	1
Kentucky	1,928	$11.75	$11.85	16
Indiana	1,486	$11.77	$11.85	16
Iowa	1,173	$11.81	$11.85	9
Louisiana	905	$11.82	$11.85	18
South Carolina	830	$11.81	$11.85	13
Mississippi	826	$11.76	$11.85	7
Utah	740	$11.82	$11.85	4
South Dakota	707	$11.83	$11.85	3
Rhode Island	597	$11.85	$11.85	2
Puerto Rico	554	$11.74	$11.85	8
Arkansas	457	$11.80	$11.85	14
Nebraska	422	$11.83	$11.85	3
Idaho	359	$11.73	$11.85	3
Maine	336	$11.82	$11.85	1
Missouri	197	$11.85	$11.85	8
U.S. Virgin Islands	157	$11.85	$11.85	3
North Dakota	146	$11.85	$11.85	2
Connecticut	140	$11.72	$11.85	1
Wyoming	39	$11.85	$11.85	1
Delaware	29	$11.85	$11.85	1
New Hampshire	18	$11.85	$11.85	1
District of Columbia	17	$11.85	$11.85	1
Montana	14	$11.85	$11.85	1

Related codes

86003Measurement of antibody (ige) to allergic substance$5.11
86039Measurement of antibody for assessment of autoimmune disorder$10.93
86037Antineutrophil cytoplasmic antibody titer$11.81
86008Measurement of antibody (ige) to allergic substance$17.54
86036Screening test for antineutrophil cytoplasmic antibody$11.80
86015Measurement of actin (smooth muscle) antibody$11.80
86021Antibody identification test for white blood cell antibodies$14.74
86001Measurement of antibody (igg) to allergic substance$6.19
86077Blood bank physician services for cross match and/or evaluation and wr$48.77
86060Measurement for strep antibody (strep throat)$7.15
86041Test for acetylcholine receptor binding antibody$17.97
86063Screening test for strep antibody (strep throat)$5.65

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.