How much does Medicare pay for CPT 86225?

Medicare allowed an average of $13.43 per service and paid $13.43 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $96.40, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86225?

Measurement of dna antibody, native or double stranded. It was billed 278,610 times to 235,546 Medicare beneficiaries by 703 providers in 2024.

Which specialty bills 86225 most?

Clinical Laboratory, with 239,544 services from 222 clinicians. Next are Rheumatology, Physician Assistant, Internal Medicine.

CPT 86225

Measurement of dna antibody, native or double stranded

$13.43Medicare-allowed amount per service, averaged across 278,610 services

Providers submitted

$96.40

Asking price, not received

Medicare allowed

$13.43

The fee schedule figure

Medicare paid

$13.43

Balance is patient coinsurance

Providers submitted an average of $96.40 for this code and Medicare allowed $13.43 — 7.2× 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 $13.43 (100%); the rest is the patient’s coinsurance and deductible.

Services: 278,610
Beneficiaries: 235,546
Providers billing it: 703
Total allowed: $3,741,732

What Medicare pays for CPT 86225

Across 278,610 services billed by 703 providers to 235,546 beneficiaries, Medicare allowed an average of $13.43 per service. That is 1.2 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 86225

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	239,544	204,538	$13.44	222
Rheumatology	29,802	23,295	$13.36	329
Physician Assistant	2,440	1,938	$13.39	26
Internal Medicine	2,257	1,635	$13.42	41
Pathology	2,096	1,937	$13.38	8
Nurse Practitioner	1,626	1,386	$13.39	41
Family Practice	236	227	$13.41	12
Hematology-Oncology	189	181	$13.34	5
Nephrology	97	97	$13.47	3
Pulmonary Disease	71	71	$13.38	2
Hospitalist	55	50	$13.27	2
Neurology	54	54	$13.47	3
Pediatric Medicine	31	31	$13.47	2
Gastroenterology	31	30	$13.18	2
Emergency Medicine	23	21	$13.47	1

86225 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	45,167	$13.46	$13.47	68
New Jersey	44,740	$13.46	$13.47	26
Texas	28,749	$13.41	$13.47	48
North Carolina	25,406	$13.45	$13.47	33
Florida	22,119	$13.45	$13.47	42
New York	15,120	$13.45	$13.47	49
Arizona	13,457	$13.43	$13.47	28
Georgia	9,893	$13.35	$13.47	18
Ohio	9,707	$13.43	$13.47	21
Alabama	9,539	$13.44	$13.47	21
Tennessee	6,131	$13.42	$13.47	20
Illinois	5,701	$13.44	$13.47	34
Kansas	4,641	$13.46	$13.47	17
Pennsylvania	4,436	$13.43	$13.47	16
Washington	2,974	$13.34	$13.47	11
Massachusetts	2,954	$13.47	$13.47	4
Maryland	2,775	$13.39	$13.47	24
Oklahoma	2,757	$13.40	$13.47	26
Nevada	2,095	$13.44	$13.47	3
Virginia	2,065	$13.39	$13.47	10
Wisconsin	1,822	$13.19	$13.47	13
Colorado	1,597	$13.46	$13.47	6
Minnesota	1,593	$13.38	$13.47	20
Hawaii	1,591	$13.47	$13.47	2
Michigan	1,337	$13.41	$13.47	7
Kentucky	1,286	$13.33	$13.47	16
Arkansas	1,207	$13.31	$13.47	15
Indiana	1,176	$13.39	$13.47	11
New Mexico	834	$13.33	$13.47	3
Missouri	814	$13.35	$13.47	5
Louisiana	752	$13.37	$13.47	14
South Carolina	677	$13.46	$13.47	14
Iowa	650	$13.38	$13.47	17
Idaho	532	$13.36	$13.47	7
Oregon	510	$13.40	$13.47	5
Utah	466	$13.23	$13.47	6
South Dakota	312	$13.43	$13.47	2
Nebraska	305	$13.23	$13.47	6
Puerto Rico	175	$13.42	$13.47	3
Maine	145	$13.23	$13.47	1
Mississippi	105	$13.12	$13.47	4
Rhode Island	99	$13.47	$13.47	2
Wyoming	94	$13.10	$13.47	1
New Hampshire	71	$13.47	$13.47	2
North Dakota	34	$13.47	$13.47	2

Related codes

86235Measurement of antibody for assessment of autoimmune disorder$17.49
86200Measurement of antibody for rheumatoid arthritis assessment$12.64
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.