RxDoctor Payments Data

CPT 86331

Immunologic analysis for detection of antigen or antibody

$11.64Medicare-allowed amount per service, averaged across 13,431 services
Providers submitted
$58.63

Asking price, not received

Medicare allowed
$11.64

The fee schedule figure

Medicare paid
$11.64

Balance is patient coinsurance

Providers submitted an average of $58.63 for this code and Medicare allowed $11.645.0× 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 $11.64 (100%); the rest is the patient’s coinsurance and deductible.

Services
13,431

Medicare Part B, 2024

Beneficiaries
8,141
Providers billing it
72
Total allowed
$156,337

Services × allowed amount

What Medicare pays for CPT 86331

Across 13,431 services billed by 72 providers to 8,141 beneficiaries, Medicare allowed an average of $11.64 per service. That is 1.6 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 86331

SpecialtyServicesBeneficiariesAvg allowedProviders
Clinical Laboratory13,3438,058$11.6467
Internal Medicine4543$11.742
Nurse Practitioner2725$11.742
Family Practice1615$11.741

86331 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.

StateServicesAllowedStandardized pmtProviders
California2,394$11.73$11.7410
North Carolina1,799$11.74$11.741
Texas1,511$11.71$11.747
Minnesota1,191$11.71$11.743
New Jersey940$11.74$11.743
Florida816$11.70$11.744
New York759$11.74$11.742
Arizona697$11.71$11.747
Utah493$11.74$11.742
Wisconsin471$11.74$11.741
Tennessee267$11.74$11.743
Ohio248$9.20$11.744
Kansas184$11.74$11.743
Georgia175$11.74$11.741
Alabama174$11.74$11.741
Pennsylvania173$11.74$11.742
Washington167$11.74$11.743
Massachusetts130$11.74$11.742
Kentucky126$11.74$11.741
Virginia125$11.59$11.741
Iowa125$7.78$11.741
Illinois109$11.74$11.741
Maryland88$11.74$11.741
Nevada76$11.47$11.741
New Mexico69$11.74$11.741
Oklahoma35$11.74$11.741
Maine26$11.74$11.741
South Dakota19$11.74$11.741
Colorado16$11.74$11.741
Oregon15$11.74$11.741
Hawaii13$11.28$11.741

Related codes

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.