How much does Medicare pay for CPT 86800?

Medicare allowed an average of $15.57 per service and paid $15.57 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $97.25, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 86800?

Thyroglobulin (thyroid protein) antibody measurement. It was billed 325,829 times to 260,696 Medicare beneficiaries by 562 providers in 2024.

Which specialty bills 86800 most?

Clinical Laboratory, with 282,479 services from 258 clinicians. Next are Endocrinology, Internal Medicine, Rheumatology.

CPT 86800

Thyroglobulin (thyroid protein) antibody measurement

$15.57Medicare-allowed amount per service, averaged across 325,829 services

Providers submitted

$97.25

Asking price, not received

Medicare allowed

$15.57

The fee schedule figure

Medicare paid

$15.57

Balance is patient coinsurance

Providers submitted an average of $97.25 for this code and Medicare allowed $15.57 — 6.2× 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 $15.57 (100%); the rest is the patient’s coinsurance and deductible.

Services: 325,829
Beneficiaries: 260,696
Providers billing it: 562
Total allowed: $5,073,158

What Medicare pays for CPT 86800

Across 325,829 services billed by 562 providers to 260,696 beneficiaries, Medicare allowed an average of $15.57 per service. That is 1.2 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 86800

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	282,479	231,165	$15.57	258
Endocrinology	20,600	14,001	$15.50	129
Internal Medicine	8,929	5,039	$15.55	35
Rheumatology	6,553	5,228	$15.54	53
Nurse Practitioner	1,888	1,574	$15.54	37
Pathology	1,180	1,102	$15.48	10
Family Practice	1,045	689	$15.58	14
General Practice	1,024	371	$15.59	1
Obstetrics & Gynecology	947	601	$15.53	7
Hematology-Oncology	568	427	$15.54	7
Physician Assistant	393	278	$15.55	8
Urology	171	170	$15.59	1
Emergency Medicine	52	51	$15.59	2

86800 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	51,226	$15.58	$15.59	33
California	50,099	$15.58	$15.59	55
Florida	40,690	$15.58	$15.59	57
New York	30,528	$15.57	$15.59	83
Texas	29,630	$15.56	$15.59	46
North Carolina	22,289	$15.58	$15.59	11
Arizona	14,869	$15.54	$15.59	25
Ohio	10,998	$15.57	$15.59	13
Massachusetts	8,372	$15.58	$15.59	17
Georgia	7,385	$15.59	$15.59	6
Tennessee	7,004	$15.52	$15.59	21
Alabama	5,872	$15.57	$15.59	9
Illinois	5,811	$15.59	$15.59	9
Kansas	5,326	$15.58	$15.59	6
Maryland	4,716	$15.56	$15.59	18
Pennsylvania	4,556	$15.58	$15.59	8
Nevada	3,165	$15.55	$15.59	5
Oklahoma	2,911	$15.54	$15.59	6
Michigan	2,846	$15.58	$15.59	11
Washington	2,437	$15.58	$15.59	8
Colorado	2,057	$15.59	$15.59	4
Virginia	1,615	$15.17	$15.59	15
Minnesota	1,453	$15.56	$15.59	6
Wisconsin	1,055	$15.37	$15.59	4
Hawaii	1,046	$15.52	$15.59	2
Mississippi	871	$15.35	$15.59	10
Oregon	871	$15.43	$15.59	3
North Dakota	752	$15.59	$15.59	2
Kentucky	750	$15.37	$15.59	12
Utah	723	$15.57	$15.59	7
Indiana	577	$15.49	$15.59	7
New Mexico	507	$15.46	$15.59	2
South Carolina	474	$15.45	$15.59	6
Missouri	404	$15.56	$15.59	2
Rhode Island	318	$15.59	$15.59	4
Puerto Rico	276	$15.02	$15.59	5
Iowa	249	$15.59	$15.59	4
Nebraska	234	$15.44	$15.59	2
Louisiana	221	$15.59	$15.59	2
Idaho	191	$15.38	$15.59	5
South Dakota	149	$15.36	$15.59	3
Maine	134	$15.59	$15.59	1
New Hampshire	93	$15.59	$15.59	4
Connecticut	46	$15.59	$15.59	1
Wyoming	18	$15.59	$15.59	1
U.S. Virgin Islands	15	$15.59	$15.59	1

Related codes

86803Hepatitis c antibody measurement$13.94
86850Screening test for red blood cell antibodies$9.54
86880Red blood cell antibody detection test$5.28
86832Assessment of antibody to human leukocyte antigens (hla)$301.77
86833Assessment of antibody to human leukocyte antigens (hla)$302.29
86812Immunologic analysis for autoimmune disease$25.27
86870Identification of red blood cell antibodies$85.79

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.