How much does Medicare pay for CPT 86769?

Medicare allowed an average of $41.06 per service and paid $41.06 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $86.53, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86769?

Measure of severe acute respiratory syndrome coronavirus 2 (covid-19) antibody. It was billed 104,577 times to 54,464 Medicare beneficiaries by 161 providers in 2024.

Which specialty bills 86769 most?

Clinical Laboratory, with 83,778 services from 101 clinicians. Next are Internal Medicine, Rheumatology, Endocrinology.

CPT 86769

Measure of severe acute respiratory syndrome coronavirus 2 (covid-19) antibody

$41.06Medicare-allowed amount per service, averaged across 104,577 services

Providers submitted

$86.53

Asking price, not received

Medicare allowed

$41.06

The fee schedule figure

Medicare paid

$41.06

Balance is patient coinsurance

Providers submitted an average of $86.53 for this code and Medicare allowed $41.06 — 2.1× 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 $41.06 (100%); the rest is the patient’s coinsurance and deductible.

Services: 104,577
Beneficiaries: 54,464
Providers billing it: 161
Total allowed: $4,293,932

What Medicare pays for CPT 86769

Across 104,577 services billed by 161 providers to 54,464 beneficiaries, Medicare allowed an average of $41.06 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 86769

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	83,778	45,165	$41.06	101
Internal Medicine	11,582	5,040	$41.15	29
Rheumatology	3,852	1,607	$41.05	6
Endocrinology	2,168	586	$40.63	1
Family Practice	1,389	926	$41.24	9
Hematology-Oncology	615	331	$41.22	2
Gastroenterology	490	379	$40.45	3
Physician Assistant	267	149	$41.29	2
Nurse Practitioner	223	128	$41.12	3
Obstetrics & Gynecology	116	73	$40.96	2
Pathology	55	41	$41.29	2
General Practice	42	39	$41.29	1

86769 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	25,234	$40.60	$41.29	28
New Jersey	20,433	$41.26	$41.29	11
Florida	14,864	$41.28	$41.29	17
New York	14,226	$41.06	$41.29	26
Texas	6,845	$41.20	$41.29	19
North Carolina	5,993	$41.26	$41.29	8
Arizona	2,112	$41.07	$41.27	3
Missouri	2,089	$41.01	$41.29	2
Massachusetts	1,830	$41.29	$41.29	3
Tennessee	1,724	$41.17	$41.29	4
Alabama	1,560	$41.24	$41.29	4
Ohio	1,519	$41.29	$41.29	3
Nevada	1,155	$41.29	$41.29	1
Pennsylvania	1,090	$41.29	$41.29	4
Georgia	922	$41.17	$41.29	3
Maryland	705	$41.23	$41.29	2
Illinois	559	$41.29	$41.29	1
Minnesota	375	$41.29	$41.29	2
Kansas	373	$41.29	$41.29	2
Washington	257	$41.29	$41.29	2
Oklahoma	205	$41.29	$41.29	3
Colorado	133	$41.29	$41.29	2
Virginia	87	$40.49	$41.29	1
Nebraska	64	$41.29	$41.29	1
Hawaii	45	$40.17	$41.29	2
Kentucky	44	$41.29	$41.29	1
Louisiana	39	$41.29	$41.29	1
Utah	28	$39.96	$41.29	1
Michigan	22	$41.29	$41.29	1
Oregon	21	$41.29	$41.29	1
Wisconsin	12	$41.29	$41.29	1
Indiana	12	$41.29	$41.29	1

Related codes

86704Hepatitis b core antibody measurement$11.79
86706Hepatitis b surface antibody measurement$10.51
86708Measurement of hepatitis a antibody$12.13
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.