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CPT 86638

Analysis for antibody to coxiella burnetii (q fever bacteria)

$11.88Medicare-allowed amount per service, averaged across 2,029 services
Providers submitted
$76.28

Asking price, not received

Medicare allowed
$11.88

The fee schedule figure

Medicare paid
$11.88

Balance is patient coinsurance

Providers submitted an average of $76.28 for this code and Medicare allowed $11.88 — 6.4× 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 $11.88 (100%); the rest is the patient’s coinsurance and deductible.

Services
2,029

Medicare Part B, 2024

Beneficiaries
842
Providers billing it
19
Total allowed
$24,105

Services × allowed amount

What Medicare pays for CPT 86638

Across 2,029 services billed by 19 providers to 842 beneficiaries, Medicare allowed an average of $11.88 per service. That is 2.4 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 86638

SpecialtyServicesBeneficiariesAvg allowedProviders
Clinical Laboratory2,029842$11.8819

86638 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.

StateServicesAllowedStandardized pmtProviders
New Jersey637$11.88$11.883
California299$11.88$11.883
North Carolina244$11.88$11.882
Massachusetts195$11.88$11.882
Kansas136$11.88$11.881
Georgia131$11.88$11.881
Minnesota126$11.88$11.881
Texas106$11.88$11.883
Florida74$11.88$11.881
Illinois62$11.88$11.881
Arizona19$11.88$11.881

Related codes

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.