C-Reactive Protein (CRP) (CPT 86140)
Medicare Rate vs. Lab Charges
Medicare pays $5.09 for this test. Labs commonly charge $25.00–$95.00. That's a 391%–1766% markup above what Medicare pays.
What This Test Is
CRP is an inflammatory marker. Elevated CRP indicates inflammation from infection, autoimmune disease, or cardiovascular disease. High-sensitivity CRP (hs-CRP) is used to assess cardiovascular risk. It's ordered when evaluating fever, joint pain, or assessing inflammation.
Medicare Rate vs. Lab Charges
| Medicare Allowable Rate | $5.09 |
| Typical Lab Charge Range | $25.00–$95.00 |
| Average Markup Above Medicare | 391%–1766% |
Does Medicare Cover This Test?
Yes, Medicare Part B covers CRP testing when ordered to evaluate inflammation or cardiovascular risk in appropriate clinical contexts.
Common Reasons for Denial
- Routine cardiovascular screening without symptoms or risk factors
- Tested too frequently without clinical indication
- No diagnosis code documenting reason (fever, inflammation, cardiovascular assessment)
- Duplicate test within short timeframe
- Pure screening without medical justification
What To Do If You're Overcharged
If you received a lab bill that seems unusually high compared to Medicare rates:
- Check your Explanation of Benefits (EOB) from Medicare or your insurance to see what should have been paid.
- Request an itemized bill from the lab showing all charges.
- Compare to GougeStop rates for your area to see if the charge is reasonable.
- Contact the lab's billing department to dispute erroneous charges or negotiate a lower rate.
- File an appeal with Medicare if a claim was incorrectly denied.
Frequently Asked Questions
A: Inflammation from some cause—infection, autoimmune disease, heart disease, or even stress/poor sleep. It's non-specific; your doctor must interpret with other findings.
A: High-sensitivity CRP (hs-CRP) can help assess CV risk, but it's not a screening test for everyone. Your doctor uses it in context of other risk factors.
A: Yes. Early infections or certain conditions may not elevate CRP significantly. Your doctor interprets all results together.