How much does Medicare pay for CPT 86431?

Medicare allowed an average of $5.55 per service and paid $5.55 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $44.02, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86431?

Rheumatoid factor level. It was billed 513,177 times to 452,951 Medicare beneficiaries by 1,267 providers in 2024.

Which specialty bills 86431 most?

Clinical Laboratory, with 461,742 services from 340 clinicians. Next are Rheumatology, Pathology, Internal Medicine.

CPT 86431

Rheumatoid factor level

$5.55Medicare-allowed amount per service, averaged across 513,177 services

Providers submitted

$44.02

Asking price, not received

Medicare allowed

$5.55

The fee schedule figure

Medicare paid

$5.55

Balance is patient coinsurance

Providers submitted an average of $44.02 for this code and Medicare allowed $5.55 — 7.9× 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 $5.55 (100%); the rest is the patient’s coinsurance and deductible.

Services: 513,177
Beneficiaries: 452,951
Providers billing it: 1,267
Total allowed: $2,848,132

What Medicare pays for CPT 86431

Across 513,177 services billed by 1,267 providers to 452,951 beneficiaries, Medicare allowed an average of $5.55 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 86431

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	461,742	406,566	$5.55	340
Rheumatology	29,584	26,211	$5.52	453
Pathology	4,813	4,671	$5.54	14
Internal Medicine	4,256	3,620	$5.54	117
Nurse Practitioner	3,116	2,996	$5.51	93
Physician Assistant	2,885	2,374	$5.54	43
Family Practice	2,382	2,253	$5.51	82
Hematology-Oncology	1,595	1,552	$5.53	51
Pulmonary Disease	458	441	$5.56	14
Gastroenterology	404	385	$5.55	2
Medical Oncology	280	267	$5.52	11
Urology	280	257	$5.56	1
Pain Management	265	264	$5.54	4
Neurology	183	183	$5.56	9
General Practice	169	164	$5.47	4

86431 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
California	107,153	$5.56	$5.56	76
New Jersey	73,649	$5.56	$5.56	33
Texas	52,443	$5.55	$5.56	95
Florida	41,882	$5.56	$5.56	70
North Carolina	41,151	$5.56	$5.56	63
New York	22,540	$5.55	$5.56	146
Arizona	16,827	$5.55	$5.56	33
Ohio	15,679	$5.55	$5.56	24
Alabama	14,721	$5.55	$5.56	34
Georgia	12,554	$5.56	$5.56	41
Tennessee	12,222	$5.53	$5.56	88
Illinois	11,170	$5.55	$5.56	54
Kansas	10,276	$5.56	$5.56	13
Massachusetts	7,890	$5.56	$5.56	22
Pennsylvania	7,269	$5.55	$5.56	22
Washington	6,943	$5.55	$5.56	18
Maryland	6,071	$5.54	$5.56	51
Oklahoma	5,661	$5.55	$5.56	37
North Dakota	4,506	$5.56	$5.56	3
Wisconsin	3,767	$5.47	$5.56	15
Virginia	3,672	$5.54	$5.56	15
Nevada	3,297	$5.56	$5.56	3
Colorado	3,053	$5.55	$5.56	9
Hawaii	3,031	$5.54	$5.56	2
Minnesota	2,611	$5.54	$5.56	24
South Carolina	2,505	$5.54	$5.56	35
Kentucky	2,398	$5.52	$5.56	25
Michigan	2,167	$5.53	$5.56	11
Oregon	2,136	$5.54	$5.56	14
Louisiana	1,801	$5.53	$5.56	18
New Mexico	1,673	$5.51	$5.56	5
Indiana	1,544	$5.53	$5.56	17
Iowa	1,319	$5.53	$5.56	27
Arkansas	1,238	$5.52	$5.56	28
Mississippi	1,210	$5.52	$5.56	18
Missouri	1,035	$5.54	$5.56	21
Utah	819	$5.52	$5.56	14
Nebraska	523	$5.53	$5.56	4
Idaho	453	$5.46	$5.56	7
South Dakota	400	$5.56	$5.56	4
Maine	388	$5.56	$5.56	5
Rhode Island	359	$5.56	$5.56	1
Connecticut	327	$5.54	$5.56	2
Puerto Rico	310	$5.53	$5.56	4
Wyoming	130	$5.45	$5.56	2
Montana	113	$5.52	$5.56	1
District of Columbia	89	$5.56	$5.56	3
New Hampshire	83	$5.56	$5.56	4
U.S. Virgin Islands	46	$5.56	$5.56	2
West Virginia	30	$5.56	$5.56	2
Alaska	24	$5.56	$5.56	1
Delaware	19	$5.56	$5.56	1

Related codes

86480Tuberculosis test$60.59
86430Rheumatoid factor analysis$6.01
86413Quantitative measurement of severe acute respiratory syndrome coronavi$50.34
86481Tuberculosis test$96.78
86403Screening test for presence of antibody$11.28

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.