How much does Medicare pay for CPT 86301?

Medicare allowed an average of $20.37 per service and paid $20.37 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $122.59, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86301?

Immunologic analysis for detection of tumor antigen, quantitative; ca 19-9. It was billed 111,481 times to 56,100 Medicare beneficiaries by 359 providers in 2024.

Which specialty bills 86301 most?

Clinical Laboratory, with 91,342 services from 160 clinicians. Next are Pathology, Hematology-Oncology, Medical Oncology.

CPT 86301

Immunologic analysis for detection of tumor antigen, quantitative; ca 19-9

$20.37Medicare-allowed amount per service, averaged across 111,481 services

Providers submitted

$122.59

Asking price, not received

Medicare allowed

$20.37

The fee schedule figure

Medicare paid

$20.37

Balance is patient coinsurance

Providers submitted an average of $122.59 for this code and Medicare allowed $20.37 — 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 $20.37 (100%); the rest is the patient’s coinsurance and deductible.

Services: 111,481
Beneficiaries: 56,100
Providers billing it: 359
Total allowed: $2,270,868

What Medicare pays for CPT 86301

Across 111,481 services billed by 359 providers to 56,100 beneficiaries, Medicare allowed an average of $20.37 per service. That is 2.0 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 86301

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	91,342	48,944	$20.38	160
Pathology	8,412	2,653	$20.39	7
Hematology-Oncology	8,295	2,812	$20.32	136
Medical Oncology	2,046	743	$20.30	31
Internal Medicine	351	222	$20.39	7
Hematology	285	99	$20.39	5
Obstetrics & Gynecology	210	204	$20.39	3
Cardiology	193	186	$20.39	1
Family Practice	94	94	$20.39	1
General Surgery	77	61	$20.39	2
Physician Assistant	74	25	$20.39	2
Nurse Practitioner	50	24	$20.39	2
Hospitalist	37	21	$20.39	1
Gastroenterology	15	12	$20.39	1

86301 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	26,564	$20.38	$20.39	57
New Jersey	17,000	$20.38	$20.39	10
Florida	14,187	$20.38	$20.39	15
Texas	9,557	$20.37	$20.39	30
New York	7,434	$20.39	$20.39	54
North Carolina	4,187	$20.38	$20.39	3
Arizona	3,992	$20.39	$20.39	3
Georgia	2,962	$20.39	$20.39	6
Kansas	2,902	$20.39	$20.39	5
Ohio	2,390	$20.32	$20.39	9
Pennsylvania	2,232	$20.38	$20.39	11
Alabama	1,804	$20.29	$20.39	11
Washington	1,532	$20.38	$20.39	6
Virginia	1,489	$20.33	$20.39	22
Minnesota	1,481	$20.38	$20.39	9
Illinois	1,367	$20.39	$20.39	11
Maryland	1,101	$20.37	$20.39	7
Tennessee	1,015	$20.30	$20.39	8
Massachusetts	996	$20.39	$20.39	3
Nevada	754	$20.37	$20.39	9
Wisconsin	741	$20.37	$20.39	3
Hawaii	689	$20.33	$20.39	2
Michigan	646	$20.31	$20.39	6
Oklahoma	574	$20.36	$20.39	3
Arkansas	504	$20.09	$20.39	6
Mississippi	450	$20.29	$20.39	5
South Carolina	415	$20.05	$20.39	11
Colorado	388	$20.35	$20.39	1
Utah	339	$20.39	$20.39	3
Louisiana	315	$20.39	$20.39	2
New Mexico	305	$20.33	$20.39	4
Iowa	213	$20.29	$20.39	4
Puerto Rico	209	$20.30	$20.39	5
Maine	189	$20.39	$20.39	4
Nebraska	182	$20.39	$20.39	1
Oregon	144	$20.20	$20.39	4
South Dakota	72	$20.39	$20.39	1
Indiana	62	$20.39	$20.39	1
Kentucky	30	$20.39	$20.39	1
Rhode Island	25	$20.39	$20.39	1
Connecticut	23	$19.09	$20.39	1
North Dakota	20	$19.89	$20.39	1

Related codes

86334Immunologic analysis technique on serum (immunofixation)$19.86
86376Microsomal antibodies (autoantibody) measurement$14.24
86300Immunologic analysis for detection of tumor antigen$20.21
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
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.