How much does Medicare pay for CPT 86318?

Medicare allowed an average of $17.66 per service and paid $17.66 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $60.53, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86318?

Test for detection of infectious agent antibody, qualitative or semiquantitative. It was billed 6,813 times to 3,938 Medicare beneficiaries by 73 providers in 2024.

Which specialty bills 86318 most?

Clinical Laboratory, with 4,994 services from 7 clinicians. Next are Family Practice, Internal Medicine, Nurse Practitioner.

CPT 86318

Test for detection of infectious agent antibody, qualitative or semiquantitative

$17.66Medicare-allowed amount per service, averaged across 6,813 services

Providers submitted

$60.53

Asking price, not received

Medicare allowed

$17.66

The fee schedule figure

Medicare paid

$17.66

Balance is patient coinsurance

Providers submitted an average of $60.53 for this code and Medicare allowed $17.66 — 3.4× 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 $17.66 (100%); the rest is the patient’s coinsurance and deductible.

Services: 6,813
Beneficiaries: 3,938
Providers billing it: 73
Total allowed: $120,318

What Medicare pays for CPT 86318

Across 6,813 services billed by 73 providers to 3,938 beneficiaries, Medicare allowed an average of $17.66 per service. That is 1.7 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 86318

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	4,994	2,385	$17.66	7
Family Practice	650	594	$17.60	30
Internal Medicine	570	403	$17.73	12
Nurse Practitioner	305	292	$17.59	15
General Practice	100	80	$17.73	2
Gastroenterology	77	73	$17.35	2
Cardiology	35	35	$17.73	1
Pediatric Medicine	33	27	$17.73	1
Physician Assistant	29	29	$17.73	2
Emergency Medicine	20	20	$17.73	1

86318 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	4,978	$17.72	$17.73	5
Arkansas	288	$17.62	$17.73	15
Texas	201	$17.73	$17.73	7
Mississippi	186	$17.63	$17.73	8
Alabama	171	$17.29	$17.73	11
New York	158	$17.73	$17.73	3
Louisiana	157	$17.54	$17.73	5
North Carolina	115	$17.73	$17.73	3
Florida	92	$17.73	$17.73	2
Kentucky	90	$17.73	$17.73	1
New Jersey	77	$17.73	$17.73	1
Michigan	62	$17.73	$17.73	2
Georgia	50	$17.73	$17.73	3
New Mexico	41	$17.73	$17.73	1
Ohio	35	$9.23	$17.73	1
Illinois	35	$17.73	$17.73	1
Pennsylvania	26	$17.73	$17.73	1
Oklahoma	22	$17.73	$17.73	1
ZZ	18	$17.73	$17.73	1
Montana	11	$17.73	$17.73	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
86316Analysis for detection of tumor marker$20.36

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.