How much does Medicare pay for CPT 86316?

Medicare allowed an average of $20.36 per service and paid $20.36 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $162.35, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86316?

Analysis for detection of tumor marker. It was billed 43,175 times to 23,078 Medicare beneficiaries by 188 providers in 2024.

Which specialty bills 86316 most?

Clinical Laboratory, with 34,120 services from 81 clinicians. Next are Urology, Pathology, Physician Assistant.

CPT 86316

Analysis for detection of tumor marker

$20.36Medicare-allowed amount per service, averaged across 43,175 services

Providers submitted

$162.35

Asking price, not received

Medicare allowed

$20.36

The fee schedule figure

Medicare paid

$20.36

Balance is patient coinsurance

Providers submitted an average of $162.35 for this code and Medicare allowed $20.36 — 8.0× 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 $20.36 (100%); the rest is the patient’s coinsurance and deductible.

Services: 43,175
Beneficiaries: 23,078
Providers billing it: 188
Total allowed: $879,043

What Medicare pays for CPT 86316

Across 43,175 services billed by 188 providers to 23,078 beneficiaries, Medicare allowed an average of $20.36 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 86316

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	34,120	15,855	$20.37	81
Urology	6,424	4,954	$20.31	84
Pathology	2,261	1,933	$20.33	5
Physician Assistant	240	211	$20.25	11
Nurse Practitioner	130	125	$20.39	7

86316 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	9,058	$20.38	$20.39	1
New Jersey	5,965	$20.36	$20.39	6
California	5,541	$20.37	$20.39	12
Florida	3,225	$20.39	$20.39	5
Texas	3,099	$20.34	$20.39	36
Arizona	1,575	$20.34	$20.39	4
Ohio	1,570	$20.39	$20.39	30
Tennessee	1,328	$20.12	$20.39	10
Georgia	1,275	$20.39	$20.39	1
Massachusetts	1,247	$20.39	$20.39	14
Maryland	1,237	$20.29	$20.39	4
Kansas	1,002	$20.39	$20.39	4
Illinois	917	$20.37	$20.39	4
New York	699	$20.39	$20.39	3
Utah	655	$20.39	$20.39	1
Pennsylvania	641	$20.39	$20.39	5
Minnesota	564	$20.39	$20.39	2
Nevada	449	$20.35	$20.39	1
Alabama	435	$20.39	$20.39	2
Washington	420	$20.39	$20.39	3
Colorado	354	$20.39	$20.39	2
Oklahoma	331	$20.33	$20.39	3
Hawaii	218	$20.39	$20.39	2
South Carolina	213	$20.39	$20.39	9
Kentucky	209	$20.39	$20.39	6
New Mexico	190	$20.39	$20.39	1
Virginia	160	$20.39	$20.39	3
Wisconsin	149	$20.26	$20.39	2
Nebraska	101	$20.27	$20.39	4
Iowa	76	$20.39	$20.39	2
Michigan	64	$20.09	$20.39	2
Maine	59	$20.39	$20.39	1
Louisiana	56	$20.39	$20.39	1
Oregon	48	$20.39	$20.39	1
Indiana	45	$19.53	$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
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
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.