CPT 86235

Across 1,639,127 services billed by 751 providers to 284,384 beneficiaries, Medicare allowed an average of $17.49 per service. That is 5.8 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.

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.

• 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
• 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

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.

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