How much does Medicare pay for CPT 86328?

Medicare allowed an average of $44.04 per service and paid $44.04 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $91.14, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86328?

Test for detection of severe acute respiratory syndrome coronavirus 2 (covid-19) antibody, qualitative or semiquantitative. It was billed 6,594 times to 4,399 Medicare beneficiaries by 81 providers in 2024.

Which specialty bills 86328 most?

Internal Medicine, with 2,401 services from 21 clinicians. Next are Clinical Laboratory, Anesthesiology, Family Practice.

CPT 86328

Test for detection of severe acute respiratory syndrome coronavirus 2 (covid-19) antibody, qualitative or semiquantitative

$44.04Medicare-allowed amount per service, averaged across 6,594 services

Providers submitted

$91.14

Asking price, not received

Medicare allowed

$44.04

The fee schedule figure

Medicare paid

$44.04

Balance is patient coinsurance

Providers submitted an average of $91.14 for this code and Medicare allowed $44.04 — 2.1× 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 $44.04 (100%); the rest is the patient’s coinsurance and deductible.

Services: 6,594
Beneficiaries: 4,399
Providers billing it: 81
Total allowed: $290,400

What Medicare pays for CPT 86328

Across 6,594 services billed by 81 providers to 4,399 beneficiaries, Medicare allowed an average of $44.04 per service. That is 1.5 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 86328

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	2,401	1,253	$43.56	21
Clinical Laboratory	1,127	1,051	$44.37	5
Anesthesiology	1,068	499	$44.37	1
Family Practice	958	724	$44.22	19
Nurse Practitioner	499	383	$44.19	22
General Practice	162	129	$44.37	3
Physician Assistant	128	121	$44.37	5
Cardiology	124	123	$44.37	1
Pathology	72	63	$44.37	1
Emergency Medicine	19	18	$44.33	1
Pulmonary Disease	19	18	$44.37	1
Critical Care (Intensivists)	17	17	$44.37	1

86328 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 York	2,039	$43.50	$44.37	7
California	1,979	$44.35	$44.37	7
Florida	658	$44.34	$44.37	15
Texas	439	$44.37	$44.37	10
Alabama	166	$43.67	$44.37	5
New Jersey	137	$44.37	$44.37	4
Michigan	133	$44.37	$44.37	4
Arkansas	126	$44.37	$44.37	2
North Carolina	124	$44.37	$44.37	2
Delaware	116	$44.37	$44.37	2
Maryland	111	$44.34	$44.37	2
Louisiana	106	$43.69	$44.37	2
Virginia	97	$44.11	$44.37	2
Ohio	93	$44.37	$44.37	1
Colorado	63	$44.37	$44.37	2
Wyoming	39	$44.37	$44.37	3
South Carolina	36	$44.37	$44.37	2
Tennessee	24	$44.37	$44.37	2
Mississippi	23	$44.37	$44.37	1
Oklahoma	21	$44.37	$44.37	1
Missouri	16	$36.92	$44.37	1
West Virginia	13	$44.37	$44.37	1
Utah	12	$44.37	$44.37	1
Georgia	12	$44.37	$44.37	1
Montana	11	$44.37	$44.37	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.