How much does Medicare pay for CPT 86704?

Medicare allowed an average of $11.79 per service and paid $11.79 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $88.80, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86704?

Hepatitis b core antibody measurement. It was billed 190,176 times to 182,589 Medicare beneficiaries by 547 providers in 2024.

Does 86704 pay differently in an office than a hospital?

Yes. The allowed amount averaged $11.79 in an office setting and $11.81 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 86704 most?

Clinical Laboratory, with 174,065 services from 213 clinicians. Next are Pathology, Internal Medicine, Rheumatology.

CPT 86704

Hepatitis b core antibody measurement

$11.79Medicare-allowed amount per service, averaged across 190,176 services

Providers submitted

$88.80

Asking price, not received

Medicare allowed

$11.79

The fee schedule figure

Medicare paid

$11.79

Balance is patient coinsurance

Providers submitted an average of $88.80 for this code and Medicare allowed $11.79 — 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 $11.79 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $11.79
Hospital / facility: $11.81

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 190,154 services were billed in an office setting and 22 in a facility.

Services: 190,176
Beneficiaries: 182,589
Providers billing it: 547
Total allowed: $2,242,175

What Medicare pays for CPT 86704

Across 190,176 services billed by 547 providers to 182,589 beneficiaries, Medicare allowed an average of $11.79 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 86704

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	174,065	167,228	$11.79	213
Pathology	7,252	6,606	$11.79	13
Internal Medicine	2,933	2,922	$11.80	107
Rheumatology	1,500	1,480	$11.70	43
Family Practice	1,339	1,329	$11.81	37
Nurse Practitioner	1,206	1,198	$11.78	52
Physician Assistant	705	699	$11.78	27
Hematology-Oncology	668	632	$11.76	31
Medical Oncology	235	226	$11.73	10
Obstetrics & Gynecology	61	60	$11.62	3
Gastroenterology	47	47	$11.37	3
Nephrology	39	38	$11.81	2
General Practice	37	37	$11.81	1
Hematology	23	23	$11.81	1
Geriatric Medicine	23	23	$11.81	1

86704 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	29,866	$11.79	$11.81	18
California	27,369	$11.79	$11.81	48
Texas	26,110	$11.80	$11.81	36
Florida	23,023	$11.79	$11.81	24
North Carolina	16,078	$11.80	$11.81	16
Massachusetts	8,802	$11.81	$11.81	188
Illinois	7,022	$11.81	$11.81	18
Arizona	5,469	$11.78	$11.81	4
Ohio	4,804	$11.78	$11.81	10
Georgia	4,782	$11.81	$11.81	3
Washington	4,674	$11.79	$11.80	14
Alabama	4,178	$11.79	$11.81	2
Kansas	4,121	$11.81	$11.81	3
New York	3,892	$11.80	$11.81	28
Pennsylvania	3,057	$11.79	$11.81	15
Oklahoma	2,607	$11.76	$11.81	29
Maryland	2,441	$11.79	$11.81	6
Nevada	2,298	$11.78	$11.81	3
Minnesota	1,626	$11.74	$11.81	5
Colorado	1,466	$11.74	$11.81	3
Oregon	1,175	$11.77	$11.81	6
Virginia	1,094	$11.78	$11.81	4
Michigan	1,074	$11.78	$11.81	22
Tennessee	718	$11.70	$11.81	3
Hawaii	467	$11.62	$11.81	2
New Mexico	310	$11.75	$11.81	1
South Carolina	305	$11.68	$11.81	2
South Dakota	217	$11.81	$11.81	2
Wisconsin	211	$10.51	$11.81	6
Nebraska	172	$11.71	$11.81	1
Kentucky	123	$11.72	$11.81	2
Utah	102	$11.81	$11.81	2
New Hampshire	76	$11.81	$11.81	2
Connecticut	73	$11.81	$11.81	1
Louisiana	66	$11.81	$11.81	3
Iowa	55	$11.27	$11.81	3
Rhode Island	37	$11.81	$11.81	2
North Dakota	36	$11.81	$11.81	1
Puerto Rico	35	$11.07	$11.81	1
Missouri	34	$11.81	$11.81	2
Maine	31	$11.81	$11.81	1
Mississippi	27	$11.04	$11.81	2
Delaware	20	$11.81	$11.81	1
Indiana	18	$11.81	$11.81	1
U.S. Virgin Islands	15	$11.81	$11.81	1

Related codes

86706Hepatitis b surface antibody measurement$10.51
86708Measurement of hepatitis a antibody$12.13
86769Measure of severe acute respiratory syndrome coronavirus 2 (covid-19)$41.06
86753Analysis for antibody to protozoa (parasite)$12.14
86705Hepatitis b core antibody (igm) measurement$11.52
86780Analysis for antibody$12.96
86709Measurement of hepatitis a antibody (igm)$11.02
86757Analysis for antibody to rickettsia (bacteria)$18.93
86787Analysis for antibody to varicella-zoster virus (chicken pox)$12.59
86738Analysis for antibody to mycoplasma (bacteria)$12.93
86762Analysis for antibody to rubella (german measles virus)$14.07
86765Analysis for antibody to rubeola (measles virus)$12.59

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.