How much does Medicare pay for CPT 86617?

Medicare allowed an average of $15.17 per service and paid $15.17 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $113.44, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86617?

Confirmation test for antibody to borrelia burgdorferi (lyme disease bacteria). It was billed 127,653 times to 58,954 Medicare beneficiaries by 104 providers in 2024.

Which specialty bills 86617 most?

Clinical Laboratory, with 127,141 services from 99 clinicians. Next are Rheumatology, Family Practice, Pathology.

CPT 86617

Confirmation test for antibody to borrelia burgdorferi (lyme disease bacteria)

$15.17Medicare-allowed amount per service, averaged across 127,653 services

Providers submitted

$113.44

Asking price, not received

Medicare allowed

$15.17

The fee schedule figure

Medicare paid

$15.17

Balance is patient coinsurance

Providers submitted an average of $113.44 for this code and Medicare allowed $15.17 — 7.5× 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 $15.17 (100%); the rest is the patient’s coinsurance and deductible.

Services: 127,653
Beneficiaries: 58,954
Providers billing it: 104
Total allowed: $1,936,496

What Medicare pays for CPT 86617

Across 127,653 services billed by 104 providers to 58,954 beneficiaries, Medicare allowed an average of $15.17 per service. That is 2.2 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 86617

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	127,141	58,625	$15.17	99
Rheumatology	374	247	$15.18	1
Family Practice	57	29	$15.18	1
Pathology	36	18	$15.18	1
Obstetrics & Gynecology	34	24	$14.37	1
Internal Medicine	11	11	$15.18	1

86617 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	69,840	$15.18	$15.18	12
North Carolina	17,672	$15.16	$15.18	4
New York	8,213	$15.17	$15.18	9
Massachusetts	7,051	$15.18	$15.18	3
Florida	4,836	$15.18	$15.18	4
Pennsylvania	3,247	$15.16	$15.18	6
Maryland	2,804	$15.17	$15.18	4
California	2,236	$15.18	$15.18	6
Illinois	1,728	$15.18	$15.18	2
Texas	1,424	$15.16	$15.18	5
Georgia	1,405	$15.18	$15.18	1
Tennessee	985	$15.15	$15.18	3
Ohio	925	$15.18	$15.18	7
Virginia	920	$15.18	$15.18	5
Arizona	618	$15.18	$15.18	2
Kansas	617	$15.18	$15.18	3
Alabama	414	$15.18	$15.18	1
Oklahoma	395	$15.18	$15.18	3
Wisconsin	390	$15.18	$15.18	4
Minnesota	356	$15.18	$15.18	4
Kentucky	306	$15.09	$15.18	1
Rhode Island	262	$15.07	$15.18	1
Indiana	158	$15.18	$15.18	1
Utah	155	$15.18	$15.18	1
Maine	122	$15.18	$15.18	1
Colorado	100	$15.18	$15.18	1
Oregon	94	$15.18	$15.18	1
Washington	83	$15.18	$15.18	2
Nevada	81	$15.18	$15.18	1
Iowa	78	$15.18	$15.18	2
Connecticut	44	$15.18	$15.18	1
Hawaii	41	$15.18	$15.18	1
South Dakota	32	$15.18	$15.18	1
U.S. Virgin Islands	21	$15.18	$15.18	1

Related codes

86618Analysis for antibody borrelia burgdorferi (lyme disease bacteria)$16.68
86635Analysis for antibody to coccidioides (bacteria)$11.21
86666Analysis for antibody to ehrlichia (bacteria transmitted by ticks)$9.97
86665Analysis for antibody to epstein-barr virus (mononucleosis virus)$17.75
86609Analysis for antibody bacteria$12.54
86684Analysis for antibody to haemophilus influenza (respiratory bacteria)$15.52
86677Analysis for antibody to helicobacter pylori (gastrointestinal bacteri$16.50
86664Analysis for antibody to epstein-barr virus (mononucleosis virus)$14.96
86696Analysis for antibody to herpes simplex virus$18.92
86695Analysis for antibody to herpes simplex virus$12.91
86671Analysis for antibody to fungus$11.99
86606Analysis for antibody to aspergillus (fungus)$14.64

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.