How much does Medicare pay for CPT 86231?

Medicare allowed an average of $11.84 per service and paid $11.84 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $114.66, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86231?

Detection of endomysial antibody (ema). It was billed 44,285 times to 42,595 Medicare beneficiaries by 68 providers in 2024.

Which specialty bills 86231 most?

Clinical Laboratory, with 44,258 services from 67 clinicians. Next are Emergency Medicine.

CPT 86231

Detection of endomysial antibody (ema)

$11.84Medicare-allowed amount per service, averaged across 44,285 services

Providers submitted

$114.66

Asking price, not received

Medicare allowed

$11.84

The fee schedule figure

Medicare paid

$11.84

Balance is patient coinsurance

Providers submitted an average of $114.66 for this code and Medicare allowed $11.84 — 9.7× 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 $11.84 (100%); the rest is the patient’s coinsurance and deductible.

Services: 44,285
Beneficiaries: 42,595
Providers billing it: 68
Total allowed: $524,334

What Medicare pays for CPT 86231

Across 44,285 services billed by 68 providers to 42,595 beneficiaries, Medicare allowed an average of $11.84 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 86231

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	44,258	42,568	$11.84	67
Emergency Medicine	27	27	$11.85	1

86231 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	15,768	$11.84	$11.85	3
New Jersey	11,346	$11.84	$11.85	7
Alabama	3,135	$11.84	$11.85	1
New York	2,595	$11.85	$11.85	3
Ohio	2,187	$11.84	$11.85	3
California	2,105	$11.83	$11.85	6
Florida	1,755	$11.85	$11.85	3
Texas	943	$11.85	$11.85	7
Washington	825	$11.85	$11.85	3
Massachusetts	597	$11.83	$11.85	3
Tennessee	442	$11.79	$11.85	2
Georgia	413	$11.85	$11.85	1
Arizona	381	$11.82	$11.85	2
Kansas	339	$11.85	$11.85	3
Illinois	318	$11.85	$11.85	1
Maryland	156	$11.85	$11.85	2
Minnesota	142	$11.79	$11.85	2
Indiana	139	$11.61	$11.85	1
Oregon	122	$11.85	$11.85	1
Colorado	118	$11.85	$11.85	2
Pennsylvania	106	$11.85	$11.85	3
Utah	88	$11.85	$11.85	1
Michigan	72	$11.85	$11.85	1
Nevada	38	$11.85	$11.85	1
Mississippi	37	$11.85	$11.85	1
Iowa	37	$11.85	$11.85	1
Hawaii	30	$11.28	$11.85	1
Virginia	24	$11.85	$11.85	1
South Dakota	16	$11.85	$11.85	1
Idaho	11	$11.85	$11.85	1

Related codes

86235Measurement of antibody for assessment of autoimmune disorder$17.49
86200Measurement of antibody for rheumatoid arthritis assessment$12.64
86225Measurement of dna antibody$13.43
86258Detection of gliadin (deamidated) (dgp) antibody$11.80
86255Screening test for antibody to noninfectious agent$12.39
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.