How much does Medicare pay for CPT 86300?

Medicare allowed an average of $20.21 per service and paid $20.21 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $122.07, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86300?

Immunologic analysis for detection of tumor antigen, quantitative; ca 15-3. It was billed 328,066 times to 134,065 Medicare beneficiaries by 964 providers in 2024.

Which specialty bills 86300 most?

Clinical Laboratory, with 191,734 services from 167 clinicians. Next are Hematology-Oncology, Pathology, Medical Oncology.

CPT 86300

Immunologic analysis for detection of tumor antigen, quantitative; ca 15-3

$20.21Medicare-allowed amount per service, averaged across 328,066 services

Providers submitted

$122.07

Asking price, not received

Medicare allowed

$20.21

The fee schedule figure

Medicare paid

$20.21

Balance is patient coinsurance

Providers submitted an average of $122.07 for this code and Medicare allowed $20.21 — 6.0× 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 $20.21 (100%); the rest is the patient’s coinsurance and deductible.

Services: 328,066
Beneficiaries: 134,065
Providers billing it: 964
Total allowed: $6,630,214

What Medicare pays for CPT 86300

Across 328,066 services billed by 964 providers to 134,065 beneficiaries, Medicare allowed an average of $20.21 per service. That is 2.4 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 86300

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	191,734	71,690	$20.13	167
Hematology-Oncology	60,222	27,622	$20.28	463
Pathology	36,557	14,440	$20.37	10
Medical Oncology	25,401	12,246	$20.30	159
Nurse Practitioner	6,531	3,944	$20.32	86
Internal Medicine	2,993	1,475	$20.31	24
Hematology	2,049	865	$20.39	13
Physician Assistant	1,831	1,134	$20.24	30
Obstetrics & Gynecology	195	189	$20.39	2
Cardiology	181	175	$20.39	1
Hospitalist	128	103	$20.39	1
Surgical Oncology	101	79	$20.39	4
Radiation Oncology	81	59	$20.39	2
Certified Clinical Nurse Specialist	34	17	$20.39	1
General Surgery	28	27	$20.39	1

86300 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	54,405	$19.54	$20.39	67
Florida	53,115	$20.37	$20.39	41
Texas	38,355	$20.34	$20.39	180
New Jersey	31,105	$20.37	$20.39	14
New York	18,449	$20.34	$20.39	106
Arizona	16,001	$20.35	$20.39	4
North Carolina	10,904	$20.37	$20.39	15
Arkansas	7,394	$20.27	$20.39	33
Kansas	7,040	$20.38	$20.39	13
Virginia	6,909	$20.34	$20.39	52
Tennessee	6,854	$20.26	$20.39	52
Nevada	6,841	$20.26	$20.39	38
Illinois	6,662	$20.35	$20.39	41
Pennsylvania	6,611	$20.36	$20.39	20
Ohio	6,521	$20.34	$20.39	11
Alabama	6,382	$20.28	$20.39	31
Colorado	5,176	$20.33	$20.39	21
Washington	4,981	$20.36	$20.39	11
Maryland	4,497	$20.32	$20.39	31
South Carolina	4,417	$20.27	$20.39	31
Mississippi	4,288	$20.03	$20.39	13
Georgia	3,599	$20.30	$20.39	13
Minnesota	2,428	$20.39	$20.39	20
Wisconsin	1,953	$20.21	$20.39	3
Massachusetts	1,600	$20.39	$20.39	4
Nebraska	1,498	$20.31	$20.36	9
Oregon	1,417	$20.28	$20.39	18
Hawaii	1,342	$20.37	$20.39	2
New Mexico	1,222	$20.29	$20.39	5
Oklahoma	1,077	$20.37	$20.39	8
Maine	788	$20.27	$20.39	7
Utah	723	$20.39	$20.39	5
Indiana	508	$20.39	$20.39	5
Wyoming	472	$20.39	$20.39	6
South Dakota	460	$20.39	$20.39	2
Michigan	438	$20.22	$20.39	5
Iowa	370	$20.39	$20.39	6
Puerto Rico	362	$20.39	$20.39	5
Louisiana	227	$20.39	$20.39	3
Connecticut	128	$20.07	$20.39	2
Delaware	115	$20.39	$20.39	1
Kentucky	112	$20.39	$20.39	2
Missouri	78	$20.21	$20.39	3
Alaska	68	$20.39	$20.39	1
Rhode Island	64	$20.39	$20.39	1
North Dakota	57	$20.39	$20.39	1
West Virginia	53	$20.39	$20.39	2

Related codes

86334Immunologic analysis technique on serum (immunofixation)$19.86
86376Microsomal antibodies (autoantibody) measurement$14.24
86364Measurement of tissue transglutaminase$11.29
86317Detection of infectious agent antibody$14.63
86335Immunologic analysis technique on body fluid$24.16
86304Immunologic analysis for detection of tumor antigen$20.36
86301Immunologic analysis for detection of tumor antigen$20.37
86381Measurement of mitochondrial antibody$24.88
86360T cell count and ratio$45.96
86341Islet cell (pancreas) antibody measurement$23.07
86316Analysis for detection of tumor marker$20.36
86320Immunologic analysis technique on serum$22.61

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.