How much does Medicare pay for CPT 86051?

Medicare allowed an average of $11.29 per service and paid $11.29 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $393.79, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86051?

Elisa detection of aquaporin-4 (neuromyelitis optica [nmo]) antibody. It was billed 1,453 times to 1,423 Medicare beneficiaries by 18 providers in 2024.

Which specialty bills 86051 most?

Clinical Laboratory, with 1,453 services from 18 clinicians.

CPT 86051

Elisa detection of aquaporin-4 (neuromyelitis optica [nmo]) antibody

$11.29Medicare-allowed amount per service, averaged across 1,453 services

Providers submitted

$393.79

Asking price, not received

Medicare allowed

$11.29

The fee schedule figure

Medicare paid

$11.29

Balance is patient coinsurance

Providers submitted an average of $393.79 for this code and Medicare allowed $11.29 — 34.9× 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 $11.29 (100%); the rest is the patient’s coinsurance and deductible.

Services: 1,453
Beneficiaries: 1,423
Providers billing it: 18
Total allowed: $16,404

What Medicare pays for CPT 86051

Across 1,453 services billed by 18 providers to 1,423 beneficiaries, Medicare allowed an average of $11.29 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 86051

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	1,453	1,423	$11.29	18

86051 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
North Carolina	884	$11.29	$11.30	1
Texas	168	$11.30	$11.30	2
New Jersey	119	$11.30	$11.30	2
Ohio	44	$11.30	$11.30	1
Massachusetts	32	$11.30	$11.30	1
Florida	26	$11.30	$11.30	1
Georgia	24	$11.30	$11.30	1
Alabama	23	$11.30	$11.30	1
Colorado	23	$11.30	$11.30	1
New York	21	$11.30	$11.30	1
Arizona	19	$11.30	$11.30	1
California	18	$11.30	$11.30	1
Oklahoma	15	$11.30	$11.30	1
Nevada	13	$11.30	$11.30	1
Tennessee	13	$11.30	$11.30	1
Illinois	11	$11.30	$11.30	1

Related codes

86003Measurement of antibody (ige) to allergic substance$5.11
86038Screening test for autoimmune disorder$11.83
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

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.