How much does Medicare pay for CPT 86200?

Medicare allowed an average of $12.64 per service and paid $12.64 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $111.48, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86200?

Measurement of antibody for rheumatoid arthritis assessment. It was billed 296,383 times to 275,086 Medicare beneficiaries by 798 providers in 2024.

Which specialty bills 86200 most?

Clinical Laboratory, with 256,767 services from 238 clinicians. Next are Rheumatology, Physician Assistant, Pathology.

CPT 86200

Measurement of antibody for rheumatoid arthritis assessment

$12.64Medicare-allowed amount per service, averaged across 296,383 services

Providers submitted

$111.48

Asking price, not received

Medicare allowed

$12.64

The fee schedule figure

Medicare paid

$12.64

Balance is patient coinsurance

Providers submitted an average of $111.48 for this code and Medicare allowed $12.64 — 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 $12.64 (100%); the rest is the patient’s coinsurance and deductible.

Services: 296,383
Beneficiaries: 275,086
Providers billing it: 798
Total allowed: $3,746,281

What Medicare pays for CPT 86200

Across 296,383 services billed by 798 providers to 275,086 beneficiaries, Medicare allowed an average of $12.64 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 86200

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	256,767	240,724	$12.64	238
Rheumatology	30,771	26,284	$12.61	404
Physician Assistant	2,661	2,188	$12.65	35
Pathology	1,993	1,959	$12.64	7
Internal Medicine	1,894	1,775	$12.62	46
Nurse Practitioner	1,439	1,392	$12.64	39
Family Practice	381	298	$12.54	10
Hematology-Oncology	115	111	$12.58	3
Hospitalist	64	62	$12.69	2
Emergency Medicine	55	51	$12.69	2
Obstetrics & Gynecology	51	51	$12.69	1
Pulmonary Disease	48	48	$12.69	3
Pediatric Medicine	43	43	$12.69	2
Hand Surgery	33	33	$12.69	2
General Practice	19	19	$12.69	1

86200 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	45,137	$12.48	$12.69	67
New Jersey	42,039	$12.68	$12.69	34
Texas	31,323	$12.66	$12.69	65
Florida	29,305	$12.68	$12.69	42
North Carolina	26,252	$12.68	$12.69	38
New York	14,189	$12.68	$12.69	44
Arizona	13,474	$12.66	$12.69	29
Georgia	10,913	$12.68	$12.69	24
Ohio	8,708	$12.67	$12.69	26
Alabama	7,814	$12.68	$12.69	12
Illinois	7,395	$12.67	$12.69	35
Kansas	7,014	$12.68	$12.69	12
Massachusetts	5,466	$12.69	$12.69	9
Tennessee	5,329	$12.63	$12.69	18
Maryland	4,407	$12.64	$12.69	50
Pennsylvania	4,228	$12.67	$12.69	17
Minnesota	3,836	$12.63	$12.69	20
Oklahoma	3,735	$12.66	$12.69	32
Washington	3,699	$12.65	$12.69	17
Wisconsin	2,217	$12.48	$12.69	14
Nevada	2,167	$12.67	$12.69	3
Virginia	1,939	$12.66	$12.69	9
Colorado	1,791	$12.68	$12.69	8
Kentucky	1,756	$12.55	$12.69	16
Michigan	1,192	$12.49	$12.69	8
Iowa	1,098	$12.57	$12.69	24
Oregon	1,055	$12.62	$12.69	7
Hawaii	933	$12.66	$12.69	2
Indiana	871	$12.59	$12.69	13
South Carolina	865	$12.64	$12.69	17
New Mexico	858	$12.50	$12.69	3
Missouri	807	$12.58	$12.69	12
Louisiana	714	$12.54	$12.69	13
Mississippi	582	$12.46	$12.69	5
Utah	581	$12.69	$12.69	10
Arkansas	533	$12.55	$12.69	10
South Dakota	443	$12.69	$12.69	3
Idaho	417	$12.53	$12.69	7
Nebraska	277	$12.64	$12.69	3
Puerto Rico	230	$12.34	$12.69	6
Maine	176	$12.63	$12.69	1
Rhode Island	151	$12.69	$12.69	1
Wyoming	109	$12.47	$12.69	1
Connecticut	106	$12.60	$12.69	1
District of Columbia	84	$12.69	$12.69	3
New Hampshire	82	$12.69	$12.69	3
U.S. Virgin Islands	26	$12.69	$12.69	1
North Dakota	22	$12.69	$12.69	1
Alaska	20	$12.69	$12.69	1
West Virginia	18	$12.69	$12.69	1

Related codes

86235Measurement of antibody for assessment of autoimmune disorder$17.49
86225Measurement of dna antibody$13.43
86258Detection of gliadin (deamidated) (dgp) antibody$11.80
86255Screening test for antibody to noninfectious agent$12.39
86231Detection of endomysial antibody (ema)$11.84
86256Measurement of antibody to noninfectious agent$12.40
86226Measurement of dna antibody$11.78
86294Immunologic analysis for detection of tumor antigen$25.01
86215Measurement of dna antibody$12.96

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.