CPT 86258
Detection of gliadin (deamidated) (dgp) antibody
Asking price, not received
The fee schedule figure
Balance is patient coinsurance
Providers submitted an average of $106.24 for this code and Medicare allowed $11.80 — 9.0× 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 $11.80 (100%); the rest is the patient’s coinsurance and deductible.
- Services
- 104,574
- Beneficiaries
- 56,140
- Providers billing it
- 140
- Total allowed
- $1,233,973
Medicare Part B, 2024
Services × allowed amount
What Medicare pays for CPT 86258
Across 104,574 services billed by 140 providers to 56,140 beneficiaries, Medicare allowed an average of $11.80 per service. That is 1.9 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 86258
| Specialty | Services | Beneficiaries | Avg allowed | Providers |
|---|---|---|---|---|
| Clinical Laboratory | 101,676 | 55,197 | $11.80 | 124 |
| Rheumatology | 1,585 | 244 | $11.78 | 1 |
| Pathology | 711 | 420 | $11.70 | 3 |
| Physician Assistant | 374 | 115 | $11.81 | 2 |
| Gastroenterology | 142 | 113 | $11.73 | 7 |
| Endocrinology | 52 | 34 | $11.81 | 2 |
| Hematology-Oncology | 34 | 17 | $11.81 | 1 |
86258 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 |
|---|---|---|---|---|
| New Jersey | 22,555 | $11.80 | $11.81 | 9 |
| North Carolina | 19,653 | $11.80 | $11.81 | 4 |
| California | 11,091 | $11.79 | $11.81 | 23 |
| Texas | 9,044 | $11.81 | $11.81 | 12 |
| New York | 5,960 | $11.80 | $11.81 | 6 |
| Arizona | 4,836 | $11.78 | $11.81 | 3 |
| Florida | 4,018 | $11.81 | $11.81 | 5 |
| Alabama | 3,952 | $11.81 | $11.81 | 2 |
| Ohio | 3,764 | $11.79 | $11.81 | 7 |
| Washington | 3,393 | $11.81 | $11.81 | 6 |
| Massachusetts | 2,309 | $11.82 | $11.81 | 6 |
| Tennessee | 1,992 | $11.77 | $11.81 | 3 |
| Georgia | 1,601 | $11.81 | $11.81 | 1 |
| Illinois | 1,093 | $11.80 | $11.81 | 9 |
| Kansas | 1,059 | $11.81 | $11.81 | 3 |
| Colorado | 1,031 | $11.79 | $11.81 | 2 |
| Utah | 965 | $11.78 | $11.81 | 2 |
| Maryland | 939 | $11.78 | $11.81 | 2 |
| Virginia | 898 | $11.69 | $11.81 | 3 |
| New Mexico | 749 | $11.69 | $11.81 | 1 |
| Oklahoma | 736 | $11.77 | $11.81 | 3 |
| Pennsylvania | 566 | $11.81 | $11.81 | 5 |
| Wisconsin | 481 | $11.66 | $11.81 | 3 |
| Oregon | 398 | $11.81 | $11.81 | 2 |
| Minnesota | 318 | $11.75 | $11.81 | 3 |
| South Dakota | 314 | $11.81 | $11.81 | 2 |
| Hawaii | 198 | $11.77 | $11.81 | 2 |
| Michigan | 175 | $11.81 | $11.81 | 2 |
| Nevada | 171 | $11.81 | $11.81 | 1 |
| Nebraska | 94 | $11.61 | $11.81 | 1 |
| Iowa | 80 | $11.81 | $11.81 | 1 |
| Mississippi | 64 | $11.81 | $11.81 | 2 |
| North Dakota | 27 | $11.81 | $11.81 | 1 |
| Indiana | 20 | $11.81 | $11.81 | 1 |
| Idaho | 19 | $11.81 | $11.81 | 1 |
| Delaware | 11 | $11.81 | $11.81 | 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
- 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.