How much does Medicare pay for CPT 86360?

Medicare allowed an average of $45.96 per service and paid $45.96 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $261.01, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86360?

T cell count and ratio, including ratio. It was billed 58,218 times to 36,084 Medicare beneficiaries by 101 providers in 2024.

Which specialty bills 86360 most?

Clinical Laboratory, with 58,204 services from 100 clinicians. Next are Pathology.

CPT 86360

T cell count and ratio, including ratio

$45.96Medicare-allowed amount per service, averaged across 58,218 services

Providers submitted

$261.01

Asking price, not received

Medicare allowed

$45.96

The fee schedule figure

Medicare paid

$45.96

Balance is patient coinsurance

Providers submitted an average of $261.01 for this code and Medicare allowed $45.96 — 5.7× 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 $45.96 (100%); the rest is the patient’s coinsurance and deductible.

Services: 58,218
Beneficiaries: 36,084
Providers billing it: 101
Total allowed: $2,675,699

What Medicare pays for CPT 86360

Across 58,218 services billed by 101 providers to 36,084 beneficiaries, Medicare allowed an average of $45.96 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 86360

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	58,204	36,073	$45.96	100
Pathology	14	11	$46.04	1

86360 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	11,685	$45.98	$46.04	6
Florida	10,751	$45.97	$46.04	7
California	9,717	$45.91	$46.04	12
North Carolina	6,518	$45.99	$46.04	4
Texas	4,500	$46.01	$46.04	5
New York	1,954	$45.95	$46.04	3
Arizona	1,689	$45.97	$46.04	3
Alabama	1,436	$46.00	$46.04	1
Minnesota	1,402	$45.88	$46.04	5
Ohio	1,303	$45.95	$46.04	3
Massachusetts	1,294	$46.04	$46.04	4
Illinois	888	$46.04	$46.04	1
Maryland	695	$46.04	$46.04	4
Pennsylvania	604	$45.98	$46.04	5
Colorado	495	$46.04	$46.04	2
Nevada	401	$46.04	$46.04	1
Tennessee	351	$46.04	$46.04	3
Washington	344	$46.03	$46.04	3
Kansas	286	$45.92	$46.04	2
Indiana	250	$45.52	$46.04	1
Oklahoma	249	$45.88	$46.04	3
Utah	209	$46.04	$46.04	2
Wisconsin	158	$45.75	$46.04	2
Oregon	145	$46.04	$46.04	2
Hawaii	137	$46.04	$46.04	2
Michigan	121	$45.00	$46.04	3
Louisiana	111	$46.04	$46.04	1
Georgia	108	$46.04	$46.04	1
Virginia	89	$45.79	$46.04	2
Maine	78	$46.04	$46.04	1
Iowa	70	$45.44	$46.04	1
Connecticut	65	$46.04	$46.04	1
Wyoming	27	$46.04	$46.04	1
Kentucky	24	$46.04	$46.04	1
South Dakota	23	$46.04	$46.04	1
New Mexico	22	$46.04	$46.04	1
Idaho	19	$42.84	$46.04	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
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.