How much does Medicare pay for CPT 86698?

Medicare allowed an average of $13.41 per service and paid $13.41 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $94.23, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86698?

Analysis for antibody to histoplasma (fungus). It was billed 7,133 times to 3,650 Medicare beneficiaries by 53 providers in 2024.

Which specialty bills 86698 most?

Clinical Laboratory, with 7,133 services from 53 clinicians.

CPT 86698

Analysis for antibody to histoplasma (fungus)

$13.41Medicare-allowed amount per service, averaged across 7,133 services

Providers submitted

$94.23

Asking price, not received

Medicare allowed

$13.41

The fee schedule figure

Medicare paid

$13.41

Balance is patient coinsurance

Providers submitted an average of $94.23 for this code and Medicare allowed $13.41 — 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 $13.41 (100%); the rest is the patient’s coinsurance and deductible.

Services: 7,133
Beneficiaries: 3,650
Providers billing it: 53
Total allowed: $95,654

What Medicare pays for CPT 86698

Across 7,133 services billed by 53 providers to 3,650 beneficiaries, Medicare allowed an average of $13.41 per service. That is 2.0 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 86698

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	7,133	3,650	$13.41	53

86698 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	1,075	$13.22	$13.51	6
Minnesota	1,052	$13.51	$13.51	3
Texas	759	$13.50	$13.51	7
Kansas	632	$13.51	$13.51	2
Nevada	536	$13.51	$13.51	1
North Carolina	507	$13.48	$13.51	1
Georgia	339	$13.51	$13.51	1
Arizona	314	$13.51	$13.51	3
Illinois	304	$13.51	$13.51	1
Florida	303	$13.50	$13.51	3
Utah	167	$13.36	$13.51	1
New Jersey	145	$13.51	$13.51	2
Tennessee	140	$13.42	$13.51	2
Oklahoma	133	$13.51	$13.51	3
Wisconsin	126	$13.23	$13.51	1
Ohio	105	$12.17	$13.51	4
Iowa	67	$13.51	$13.51	1
South Dakota	66	$13.51	$13.51	1
Kentucky	62	$13.51	$13.51	1
Washington	57	$13.51	$13.51	2
Virginia	53	$10.07	$13.51	1
Pennsylvania	50	$13.51	$13.51	1
Indiana	43	$13.23	$13.51	1
Massachusetts	32	$13.51	$13.51	1
Maryland	29	$13.51	$13.51	1
Alabama	22	$13.51	$13.51	1
New York	15	$13.51	$13.51	1

Related codes

86618Analysis for antibody borrelia burgdorferi (lyme disease bacteria)$16.68
86617Confirmation test for antibody to borrelia burgdorferi (lyme disease b$15.17
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

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.