How much does Medicare pay for CPT 86788?

Medicare allowed an average of $16.48 per service and paid $16.48 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $97.95, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86788?

Analysis for antibody (igm) to west nile virus. It was billed 2,083 times to 2,029 Medicare beneficiaries by 40 providers in 2024.

Which specialty bills 86788 most?

Clinical Laboratory, with 2,083 services from 40 clinicians.

CPT 86788

Analysis for antibody (igm) to west nile virus

$16.48Medicare-allowed amount per service, averaged across 2,083 services

Providers submitted

$97.95

Asking price, not received

Medicare allowed

$16.48

The fee schedule figure

Medicare paid

$16.48

Balance is patient coinsurance

Providers submitted an average of $97.95 for this code and Medicare allowed $16.48 — 5.9× 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 $16.48 (100%); the rest is the patient’s coinsurance and deductible.

Services: 2,083
Beneficiaries: 2,029
Providers billing it: 40
Total allowed: $34,328

What Medicare pays for CPT 86788

Across 2,083 services billed by 40 providers to 2,029 beneficiaries, Medicare allowed an average of $16.48 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 86788

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	2,083	2,029	$16.48	40

86788 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	484	$16.51	$16.51	4
Texas	366	$16.51	$16.51	6
North Carolina	347	$16.51	$16.51	1
California	191	$16.44	$16.51	5
Arizona	144	$16.51	$16.51	2
Tennessee	85	$16.51	$16.51	2
New York	55	$16.51	$16.51	2
Massachusetts	46	$16.51	$16.51	2
Georgia	42	$16.51	$16.51	1
Minnesota	40	$15.85	$16.51	2
Kansas	39	$16.51	$16.51	1
Utah	34	$16.51	$16.51	1
Ohio	33	$16.51	$16.51	2
Illinois	28	$16.51	$16.51	1
Alabama	27	$16.51	$16.51	1
Florida	21	$16.51	$16.51	1
Wisconsin	20	$15.82	$16.51	1
South Dakota	19	$16.51	$16.51	1
Colorado	18	$16.51	$16.51	1
Maryland	17	$16.51	$16.51	1
Oklahoma	14	$16.51	$16.51	1
Nevada	13	$16.51	$16.51	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
86738Analysis for antibody to mycoplasma (bacteria)$12.93
86762Analysis for antibody to rubella (german measles virus)$14.07

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.