How much does Medicare pay for CPT 86738?

Medicare allowed an average of $12.93 per service and paid $12.93 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $77.54, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86738?

Analysis for antibody to mycoplasma (bacteria). It was billed 22,325 times to 11,478 Medicare beneficiaries by 149 providers in 2024.

Which specialty bills 86738 most?

Clinical Laboratory, with 19,296 services from 117 clinicians. Next are Rheumatology, Physician Assistant, Nurse Practitioner.

CPT 86738

Analysis for antibody to mycoplasma (bacteria)

$12.93Medicare-allowed amount per service, averaged across 22,325 services

Providers submitted

$77.54

Asking price, not received

Medicare allowed

$12.93

The fee schedule figure

Medicare paid

$12.93

Balance is patient coinsurance

Providers submitted an average of $77.54 for this code and Medicare allowed $12.93 — 6.0× 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 $12.93 (100%); the rest is the patient’s coinsurance and deductible.

Services: 22,325
Beneficiaries: 11,478
Providers billing it: 149
Total allowed: $288,662

What Medicare pays for CPT 86738

Across 22,325 services billed by 149 providers to 11,478 beneficiaries, Medicare allowed an average of $12.93 per service. That is 1.9 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 86738

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	19,296	10,198	$12.94	117
Rheumatology	1,638	245	$12.90	1
Physician Assistant	476	189	$12.98	6
Nurse Practitioner	342	314	$12.85	10
Family Practice	323	303	$12.69	9
Internal Medicine	128	119	$12.98	4
Emergency Medicine	71	69	$12.98	1
Pulmonary Disease	51	41	$12.98	1

86738 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
Texas	4,010	$12.96	$12.98	7
New Jersey	3,217	$12.94	$12.96	7
California	3,066	$12.86	$12.98	9
North Carolina	2,519	$12.97	$12.98	1
Puerto Rico	2,384	$12.88	$12.98	61
Arizona	1,646	$12.93	$12.98	3
Florida	867	$12.98	$12.98	3
New York	665	$12.96	$12.98	7
Ohio	493	$12.97	$12.98	2
Mississippi	488	$12.75	$12.98	11
Tennessee	482	$12.93	$12.98	2
Illinois	441	$12.98	$12.98	2
Massachusetts	431	$12.98	$12.98	2
Iowa	278	$12.98	$12.98	8
Georgia	262	$12.98	$12.98	1
Kansas	228	$12.98	$12.98	3
Alabama	202	$12.91	$12.98	2
Oklahoma	95	$12.98	$12.98	5
Pennsylvania	95	$12.98	$12.98	2
Minnesota	66	$12.97	$12.97	1
Maryland	66	$12.98	$12.98	1
South Carolina	65	$12.73	$12.98	3
Washington	64	$12.98	$12.98	1
Colorado	55	$12.98	$12.98	1
Utah	47	$12.98	$12.98	1
Nevada	41	$12.98	$12.98	1
Hawaii	30	$12.21	$12.97	1
South Dakota	22	$12.98	$12.98	1

Related codes

86704Hepatitis b core antibody measurement$11.79
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
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.