How much does Medicare pay for CPT 86355?

Medicare allowed an average of $36.91 per service and paid $36.91 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $148.56, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86355?

Total cell count for b cells (white blood cells). It was billed 21,275 times to 14,637 Medicare beneficiaries by 72 providers in 2024.

Which specialty bills 86355 most?

Clinical Laboratory, with 21,275 services from 72 clinicians.

CPT 86355

Total cell count for b cells (white blood cells)

$36.91Medicare-allowed amount per service, averaged across 21,275 services

Providers submitted

$148.56

Asking price, not received

Medicare allowed

$36.91

The fee schedule figure

Medicare paid

$36.91

Balance is patient coinsurance

Providers submitted an average of $148.56 for this code and Medicare allowed $36.91 — 4.0× 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 $36.91 (100%); the rest is the patient’s coinsurance and deductible.

Services: 21,275
Beneficiaries: 14,637
Providers billing it: 72
Total allowed: $785,260

What Medicare pays for CPT 86355

Across 21,275 services billed by 72 providers to 14,637 beneficiaries, Medicare allowed an average of $36.91 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 86355

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	21,275	14,637	$36.91	72

86355 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	6,511	$36.90	$36.98	6
California	3,048	$36.93	$36.98	5
Florida	2,375	$36.96	$36.98	4
North Carolina	1,537	$36.96	$36.98	2
Minnesota	1,360	$36.82	$36.98	4
New York	1,126	$36.85	$36.98	2
Texas	1,112	$36.98	$36.98	6
Massachusetts	674	$36.98	$36.98	4
Arizona	621	$36.92	$36.98	3
Colorado	450	$36.98	$36.98	2
Kansas	404	$36.91	$36.98	3
Pennsylvania	343	$36.98	$36.98	4
Illinois	264	$36.98	$36.98	1
Maryland	208	$36.98	$36.98	2
Ohio	171	$36.69	$36.98	1
Nevada	161	$36.89	$36.98	1
Virginia	154	$36.17	$36.98	2
Washington	144	$36.98	$36.98	2
Oklahoma	97	$36.65	$36.98	3
Wisconsin	85	$36.98	$36.98	2
Alabama	80	$36.98	$36.98	1
Utah	64	$36.98	$36.98	2
Hawaii	60	$36.98	$36.98	2
Maine	43	$36.98	$36.98	1
Iowa	41	$36.15	$36.98	1
Georgia	39	$36.98	$36.98	1
New Mexico	29	$36.98	$36.98	1
Tennessee	28	$36.98	$36.98	1
South Dakota	18	$36.98	$36.98	1
Michigan	16	$36.98	$36.98	1
Indiana	12	$36.98	$36.98	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.