How much does Medicare pay for CPT 86161?

Medicare allowed an average of $11.74 per service and paid $11.74 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $103.78, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86161?

Measurement of complement function (immune system proteins). It was billed 8,359 times to 6,348 Medicare beneficiaries by 83 providers in 2024.

Which specialty bills 86161 most?

Clinical Laboratory, with 5,311 services from 59 clinicians. Next are Rheumatology, Hospitalist.

CPT 86161

Measurement of complement function (immune system proteins)

$11.74Medicare-allowed amount per service, averaged across 8,359 services

Providers submitted

$103.78

Asking price, not received

Medicare allowed

$11.74

The fee schedule figure

Medicare paid

$11.74

Balance is patient coinsurance

Providers submitted an average of $103.78 for this code and Medicare allowed $11.74 — 8.8× 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 $11.74 (100%); the rest is the patient’s coinsurance and deductible.

Services: 8,359
Beneficiaries: 6,348
Providers billing it: 83
Total allowed: $98,135

What Medicare pays for CPT 86161

Across 8,359 services billed by 83 providers to 6,348 beneficiaries, Medicare allowed an average of $11.74 per service. That is 1.3 services per beneficiary, so this is a code patients typically receive more than once. 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 86161

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	5,311	4,702	$11.76	59
Rheumatology	3,012	1,614	$11.71	23
Hospitalist	36	32	$11.76	1

86161 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	2,908	$11.71	$11.76	16
Florida	1,330	$11.76	$11.76	10
North Carolina	837	$11.76	$11.76	4
New Jersey	718	$11.76	$11.76	4
Texas	666	$11.74	$11.76	10
Massachusetts	339	$11.74	$11.76	6
Colorado	220	$11.76	$11.76	1
Arizona	186	$11.76	$11.76	3
South Carolina	160	$11.76	$11.76	1
Kansas	117	$11.76	$11.76	2
Minnesota	109	$11.76	$11.76	2
Georgia	101	$11.76	$11.76	1
New York	96	$11.76	$11.76	2
Illinois	96	$11.76	$11.76	1
Washington	64	$11.76	$11.76	2
Tennessee	63	$11.76	$11.76	2
Alabama	62	$11.76	$11.76	1
Ohio	55	$11.76	$11.76	2
Pennsylvania	45	$11.76	$11.76	3
Utah	39	$11.76	$11.76	1
Wisconsin	38	$11.76	$11.76	1
Virginia	23	$11.76	$11.76	1
Maryland	16	$11.76	$11.76	1
Oregon	13	$11.76	$11.76	1
Nevada	12	$11.76	$11.76	1
Puerto Rico	12	$11.76	$11.76	1
Iowa	12	$11.76	$11.76	1
U.S. Virgin Islands	11	$11.76	$11.76	1
Oklahoma	11	$11.76	$11.76	1

Related codes

86140Measurement c-reactive protein for detection of infection or inflammat$5.07
86160Measurement of complement (immune system proteins)$11.73
86141Measurement c-reactive protein for detection of infection or inflammat$12.67
86147Cardiolipin antibody (tissue antibody) measurement$24.88
86146Beta 2 glycoprotein 1 antibody (autoantibody) measurement$24.73
86162Measurement of complement (immune system proteins)$19.87
86148Phospholipid antibody (autoimmune antibody) measurement$15.71
86157Measurement of cold agglutinin (protein) to detect infection or diseas$7.89

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.