How much does Medicare pay for CPT 86335?

Medicare allowed an average of $24.16 per service and paid $22.93 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $150.17, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86335?

Immunologic analysis technique on body fluid, other fluids with concentration. It was billed 137,565 times to 113,674 Medicare beneficiaries by 772 providers in 2024.

Does 86335 pay differently in an office than a hospital?

Yes. The allowed amount averaged $27.87 in an office setting and $17.33 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 86335 most?

Clinical Laboratory, with 82,366 services from 143 clinicians. Next are Pathology, Rheumatology, Internal Medicine.

CPT 86335

Immunologic analysis technique on body fluid, other fluids with concentration

$24.16Medicare-allowed amount per service, averaged across 137,565 services

Providers submitted

$150.17

Asking price, not received

Medicare allowed

$24.16

The fee schedule figure

Medicare paid

$22.93

Balance is patient coinsurance

Providers submitted an average of $150.17 for this code and Medicare allowed $24.16 — 6.2× 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 $22.93 (95%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $27.87
Hospital / facility: $17.33

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 89,189 services were billed in an office setting and 48,376 in a facility.

Services: 137,565
Beneficiaries: 113,674
Providers billing it: 772
Total allowed: $3,323,570

What Medicare pays for CPT 86335

Across 137,565 services billed by 772 providers to 113,674 beneficiaries, Medicare allowed an average of $24.16 per service. That is 1.2 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 86335

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	82,366	68,003	$28.60	143
Pathology	54,786	45,285	$17.49	617
Rheumatology	122	115	$20.09	2
Internal Medicine	110	102	$20.38	2
Hematology-Oncology	93	87	$28.29	4
Medical Oncology	37	31	$26.82	1
General Surgery	22	22	$18.79	1
Nurse Practitioner	17	17	$28.76	1
Emergency Medicine	12	12	$28.76	1

86335 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 Jersey	19,394	$28.08	$28.02	25
Texas	17,512	$25.23	$25.17	34
Florida	13,228	$25.55	$24.50	59
California	12,646	$25.56	$23.94	61
North Carolina	8,444	$26.90	$26.34	22
New York	6,094	$22.92	$19.82	44
Ohio	6,016	$21.54	$19.25	48
Massachusetts	5,697	$20.94	$17.11	27
Illinois	5,190	$19.94	$16.18	59
Pennsylvania	4,873	$20.15	$19.88	41
Georgia	4,000	$26.01	$25.01	23
Alabama	2,825	$23.80	$22.51	14
Arizona	2,715	$28.26	$28.13	8
Virginia	2,314	$21.06	$18.79	14
Maryland	2,295	$23.34	$22.88	22
Michigan	2,160	$18.50	$14.92	30
Wisconsin	2,051	$20.84	$18.43	19
Kansas	1,899	$22.99	$21.88	6
Tennessee	1,654	$27.89	$27.63	7
Connecticut	1,591	$18.08	$13.07	15
Arkansas	1,438	$16.06	$16.50	4
Washington	1,199	$23.71	$20.88	13
Iowa	1,127	$19.62	$16.79	13
Missouri	1,110	$17.41	$13.98	25
Minnesota	1,047	$18.56	$15.18	23
Colorado	1,028	$21.70	$21.43	7
Utah	917	$18.89	$16.05	9
Nebraska	825	$25.59	$24.69	3
Indiana	712	$18.92	$16.05	15
Maine	690	$19.47	$16.53	4
Nevada	678	$28.53	$28.49	2
Vermont	581	$16.81	$12.30	3
Hawaii	466	$23.57	$21.46	5
Oklahoma	462	$25.08	$25.22	7
Kentucky	290	$19.42	$16.72	10
Oregon	284	$26.72	$26.04	5
Rhode Island	267	$19.89	$16.76	5
Louisiana	257	$23.16	$23.46	7
South Carolina	242	$16.56	$12.88	2
North Dakota	241	$17.49	$13.80	4
Mississippi	202	$19.71	$19.90	6
New Hampshire	190	$16.85	$13.28	4
South Dakota	188	$26.99	$26.59	4
Delaware	124	$16.96	$16.88	1
Puerto Rico	107	$28.71	$28.76	2
Idaho	104	$16.51	$11.83	4
District of Columbia	69	$18.08	$16.91	2
ZZ	62	$17.28	$16.96	1
U.S. Virgin Islands	19	$27.70	$28.76	1
New Mexico	16	$28.76	$28.76	1
West Virginia	14	$16.89	$13.55	1
Montana	11	$17.13	$13.53	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
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
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.