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CPT 86695

Analysis for antibody to herpes simplex virus, type 1

$12.91Medicare-allowed amount per service, averaged across 27,194 services
Providers submitted
$89.26

Asking price, not received

Medicare allowed
$12.91

The fee schedule figure

Medicare paid
$12.91

Balance is patient coinsurance

Providers submitted an average of $89.26 for this code and Medicare allowed $12.91 — 6.9× 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 $12.91 (100%); the rest is the patient’s coinsurance and deductible.

Services
27,194

Medicare Part B, 2024

Beneficiaries
25,309
Providers billing it
146
Total allowed
$351,075

Services × allowed amount

What Medicare pays for CPT 86695

Across 27,194 services billed by 146 providers to 25,309 beneficiaries, Medicare allowed an average of $12.91 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 86695

SpecialtyServicesBeneficiariesAvg allowedProviders
Clinical Laboratory26,87725,006$12.91137
Pathology197185$12.876
Internal Medicine6867$12.931
Obstetrics & Gynecology5251$12.932

86695 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 Jersey5,013$12.92$12.9313
California5,007$12.91$12.9322
Florida2,824$12.89$12.9311
Texas2,479$12.91$12.9310
North Carolina2,283$12.92$12.934
New York1,563$12.92$12.9311
Arizona978$12.91$12.934
Georgia890$12.93$12.931
Alabama811$12.92$12.932
Tennessee617$12.89$12.934
Kansas555$12.93$12.934
Massachusetts516$12.93$12.932
Ohio507$12.89$12.937
Illinois491$12.93$12.933
Pennsylvania433$12.90$12.935
Maryland344$12.85$12.933
Nevada271$12.93$12.933
Michigan226$12.64$12.937
Minnesota226$12.70$12.932
Washington216$12.93$12.933
Oklahoma200$12.88$12.933
Virginia136$12.86$12.933
Colorado110$12.84$12.842
Hawaii94$12.93$12.932
Oregon78$12.93$12.932
West Virginia56$12.93$12.931
Indiana49$12.67$12.931
Wisconsin34$12.17$12.931
Louisiana33$12.93$12.932
New Mexico32$12.93$12.931
Puerto Rico24$12.44$12.931
Connecticut23$12.93$12.931
North Dakota17$12.93$12.931
Iowa17$12.93$12.931
Maine15$12.93$12.931
Mississippi13$12.93$12.931
Rhode Island13$12.93$12.931

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.