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CPT 86696

Analysis for antibody to herpes simplex virus, type 2

$18.92Medicare-allowed amount per service, averaged across 28,542 services
Providers submitted
$131.93

Asking price, not received

Medicare allowed
$18.92

The fee schedule figure

Medicare paid
$18.92

Balance is patient coinsurance

Providers submitted an average of $131.93 for this code and Medicare allowed $18.92 — 7.0× 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 $18.92 (100%); the rest is the patient’s coinsurance and deductible.

Services
28,542

Medicare Part B, 2024

Beneficiaries
26,276
Providers billing it
149
Total allowed
$540,015

Services × allowed amount

What Medicare pays for CPT 86696

Across 28,542 services billed by 149 providers to 26,276 beneficiaries, Medicare allowed an average of $18.92 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 86696

SpecialtyServicesBeneficiariesAvg allowedProviders
Clinical Laboratory28,21925,970$18.92140
Pathology202187$18.886
Internal Medicine6968$18.961
Obstetrics & Gynecology5251$18.962

86696 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 Jersey5,289$18.95$18.9613
California5,005$18.93$18.9625
Florida2,897$18.90$18.9511
Texas2,645$18.94$18.9611
North Carolina2,477$18.94$18.964
New York1,584$18.95$18.9611
Georgia1,083$18.96$18.961
Arizona1,014$18.93$18.964
Alabama860$18.94$18.962
Tennessee664$18.91$18.964
Kansas592$18.96$18.964
Massachusetts577$18.96$18.962
Illinois549$18.96$18.963
Ohio507$18.90$18.966
Pennsylvania444$18.92$18.965
Maryland379$18.86$18.963
Nevada295$18.96$18.963
Washington232$18.96$18.963
Minnesota226$18.62$18.962
Michigan215$18.12$18.966
Oklahoma204$18.81$18.963
Virginia140$18.87$18.963
Colorado118$18.96$18.962
Hawaii93$18.96$18.962
Oregon91$18.96$18.963
West Virginia67$18.96$18.961
Indiana49$18.57$18.961
Wisconsin46$17.79$18.961
Louisiana33$18.96$18.962
Puerto Rico32$18.31$18.961
New Mexico32$18.96$18.961
Connecticut26$18.96$18.961
Iowa17$18.96$18.961
North Dakota16$18.96$18.961
Rhode Island16$18.96$18.961
Maine15$18.96$18.961
Mississippi13$18.96$18.961

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.