How much does Medicare pay for CPT 86381?

Medicare allowed an average of $24.88 per service and paid $24.88 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $127.00, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86381?

Measurement of mitochondrial antibody. It was billed 60,008 times to 56,173 Medicare beneficiaries by 110 providers in 2024.

Which specialty bills 86381 most?

Clinical Laboratory, with 59,478 services from 107 clinicians. Next are Pathology.

CPT 86381

Measurement of mitochondrial antibody

$24.88Medicare-allowed amount per service, averaged across 60,008 services

Providers submitted

$127.00

Asking price, not received

Medicare allowed

$24.88

The fee schedule figure

Medicare paid

$24.88

Balance is patient coinsurance

Providers submitted an average of $127.00 for this code and Medicare allowed $24.88 — 5.1× 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 $24.88 (100%); the rest is the patient’s coinsurance and deductible.

Services: 60,008
Beneficiaries: 56,173
Providers billing it: 110
Total allowed: $1,492,999

What Medicare pays for CPT 86381

Across 60,008 services billed by 110 providers to 56,173 beneficiaries, Medicare allowed an average of $24.88 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 86381

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	59,478	55,655	$24.88	107
Pathology	530	518	$24.82	3

86381 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	8,852	$24.93	$24.94	2
New Jersey	8,483	$24.93	$24.94	6
Texas	7,228	$24.92	$24.94	7
California	6,689	$24.91	$24.94	11
Florida	5,773	$24.90	$24.94	5
Arizona	3,847	$24.88	$24.93	3
Alabama	2,479	$24.92	$24.94	2
Ohio	2,281	$24.44	$24.94	7
Georgia	1,921	$24.94	$24.94	1
Massachusetts	1,337	$24.93	$24.94	3
Kansas	1,259	$24.89	$24.94	4
New York	1,194	$24.93	$24.94	4
Illinois	1,011	$24.94	$24.94	1
Tennessee	1,000	$24.88	$24.94	3
Washington	825	$24.94	$24.94	5
Maryland	821	$24.86	$24.94	3
Pennsylvania	705	$24.91	$24.94	5
Minnesota	600	$24.91	$24.94	3
Oklahoma	565	$24.94	$24.94	3
Wisconsin	562	$24.78	$24.94	2
Colorado	519	$24.85	$24.94	3
Virginia	440	$23.07	$24.94	4
Nevada	433	$24.87	$24.94	1
Hawaii	272	$24.92	$24.94	2
Iowa	162	$24.68	$24.94	2
New Mexico	130	$24.80	$24.94	1
Oregon	119	$24.87	$24.94	3
Indiana	84	$24.94	$24.94	1
Michigan	81	$22.03	$24.35	3
Utah	80	$24.79	$24.94	2
South Dakota	70	$24.94	$24.94	1
Mississippi	67	$24.94	$24.94	2
Maine	47	$24.94	$24.94	1
Louisiana	30	$24.94	$24.94	1
Connecticut	16	$24.94	$24.94	1
North Dakota	13	$24.13	$24.94	1
Puerto Rico	13	$24.94	$24.94	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
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.