How much does Medicare pay for CPT 86366?

Medicare allowed an average of $18.02 per service and paid $18.02 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1122.20, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86366?

Test for muscle-specific kinase antibody. It was billed 10,789 times to 10,562 Medicare beneficiaries by 59 providers in 2024.

Which specialty bills 86366 most?

Clinical Laboratory, with 10,789 services from 59 clinicians.

CPT 86366

Test for muscle-specific kinase antibody

$18.02Medicare-allowed amount per service, averaged across 10,789 services

Providers submitted

$1122.20

Asking price, not received

Medicare allowed

$18.02

The fee schedule figure

Medicare paid

$18.02

Balance is patient coinsurance

Providers submitted an average of $1122.20 for this code and Medicare allowed $18.02 — 62.3× 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 $18.02 (100%); the rest is the patient’s coinsurance and deductible.

Services: 10,789
Beneficiaries: 10,562
Providers billing it: 59
Total allowed: $194,418

What Medicare pays for CPT 86366

Across 10,789 services billed by 59 providers to 10,562 beneficiaries, Medicare allowed an average of $18.02 per service. 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 86366

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	10,789	10,562	$18.02	59

86366 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
North Carolina	3,301	$18.02	$18.03	1
Florida	1,320	$18.02	$18.03	4
New Jersey	1,127	$18.03	$18.03	2
Texas	718	$18.02	$18.03	5
California	607	$18.03	$18.03	7
Massachusetts	552	$18.03	$18.03	3
Georgia	499	$18.00	$18.00	1
Minnesota	332	$18.03	$18.03	3
Kansas	323	$18.03	$18.03	3
New York	242	$18.03	$18.03	2
Illinois	211	$18.03	$18.03	1
Arizona	201	$17.93	$18.03	2
Alabama	196	$18.03	$18.03	1
Nevada	146	$18.03	$18.03	1
Ohio	146	$17.99	$18.03	2
Pennsylvania	143	$17.91	$18.03	4
Wisconsin	139	$17.93	$18.03	1
Maryland	99	$18.03	$18.03	1
Washington	88	$18.03	$18.03	2
Utah	85	$18.03	$18.03	1
Virginia	74	$18.03	$18.03	3
Iowa	70	$17.82	$18.03	1
Colorado	61	$18.03	$18.03	2
Oklahoma	36	$18.03	$18.03	2
Tennessee	32	$18.03	$18.03	2
Hawaii	21	$18.03	$18.03	1
New Mexico	20	$18.03	$18.03	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.