Summary & Overview
CPT 86902: Red Cell Antibody Identification, Indirect Antiglobulin Test
CPT code 86902 represents the laboratory procedure for red cell antibody identification using the indirect antiglobulin test, performed for each antibody detected. This test is essential in transfusion medicine, helping to prevent complications by identifying antibodies that could react with transfused blood. The code is widely used in hospital and reference laboratory settings, supporting clinical care in areas such as obstetrics, internal medicine, and pathology.
Major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare provide coverage for this laboratory service. The publication offers a comprehensive overview of payer coverage, clinical context, and relevant policy updates for CPT code 86902. Readers will gain insights into the clinical importance of antibody identification, typical sites of service, and how this code fits within broader laboratory and blood bank operations. The summary also highlights related codes and common clinical scenarios, such as maternal care for anti-D [Rh] antibodies and supervision of normal pregnancies, where this testing is frequently utilized.
This article is designed to inform healthcare professionals, laboratory administrators, and policy analysts about the national landscape for CPT code 86902, including payer coverage, clinical benchmarks, and the role of antibody identification in patient safety and quality care.
CPT Code Overview
CPT code 86902 is used to report the laboratory service of red cell antibody identification through a serologic indirect antiglobulin test, performed for each antibody detected. This procedure is a critical component of blood bank and transfusion medicine, ensuring safe transfusion practices by identifying antibodies that may cause adverse reactions. The service is typically conducted in a laboratory setting, such as a hospital or reference laboratory, where specialized testing is required to support patient care in obstetrics, internal medicine, and other clinical areas.
Clinical & Coding Specifications
Clinical Context
A patient, such as a pregnant woman, presents for laboratory evaluation to assess for the presence of red cell antibodies. This is commonly performed during prenatal care to monitor for maternal anti-D (Rh) antibodies, which can affect pregnancy outcomes. The laboratory receives a blood sample and performs a serologic red cell antibody identification using the indirect antiglobulin test. This procedure helps identify specific antibodies that may cause hemolytic disease of the fetus or newborn, or complicate transfusion therapy. The workflow involves specimen collection, laboratory analysis, and reporting of results to the ordering provider, typically in a hospital or reference laboratory setting.
Coding Specifications
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Modifiers:
- Modifier
26: Used to indicate the professional component of the laboratory service, such as interpretation by a pathologist. - Modifier
TC: Used to indicate the technical component, covering the laboratory's performance of the test.
- Modifier
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207ZC0000X | Clinical Pathology |
207Q00000X | Family Medicine |
207V00000X | Obstetrics & Gynecology |
207R00000X | Internal Medicine |
207P00000X | Pathology |
These taxonomies represent specialties commonly involved in ordering, performing, or interpreting blood bank and transfusion medicine laboratory tests.
Related Diagnoses
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Z34.00— Encounter for supervision of normal first pregnancy, unspecified trimester- Relevant for routine prenatal screening, including antibody identification to monitor for potential complications.
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Z34.80— Encounter for supervision of other normal pregnancy, unspecified trimester- Used for prenatal care in pregnancies not classified as first pregnancies, where antibody screening is also indicated.
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O36.0110— Maternal care for anti-D [Rh] antibodies, first trimester, not applicable or unspecified- Indicates maternal management for anti-D antibodies in the first trimester, requiring antibody identification.
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O36.0120— Maternal care for anti-D [Rh] antibodies, second trimester, not applicable or unspecified- Used when anti-D antibodies are present in the second trimester, necessitating ongoing antibody identification.
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O36.0130— Maternal care for anti-D [Rh] antibodies, third trimester, not applicable or unspecified- Applies to maternal care for anti-D antibodies in the third trimester, with continued antibody identification to guide clinical management.
Related CPT Codes
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86900— Blood typing; serologic (e.g., ABO)- Used to determine a patient's ABO blood group. Often performed prior to antibody identification to establish basic blood type.
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86901— Blood typing; Rh (e.g., D antigen), serologic- Used to determine Rh status (positive or negative). Frequently performed alongside ABO typing and antibody identification, especially in prenatal and transfusion settings.
Both 86900 and 86901 are commonly used together with 86902 in clinical workflows involving blood bank testing, such as prenatal screening or pre-transfusion evaluation. They establish blood group and Rh status before identifying specific antibodies with 86902.
National Reimbursement Benchmarks
For CPT code 86902, the national mean rate for BUCA (the average of major commercial payers) is $6.08, which is higher than the UnitedHealth Group mean rate of $4.89 and lower than Cigna's mean rate of $8.19. Medicare rates are not available in the input for comparison.
Rate dispersion, measured as the difference between the 75th and 25th percentiles, varies across payers. UnitedHealth Group shows the tightest range at $2.00, indicating less variability in rates, while Cigna has the widest range at $4.50, reflecting greater variability. Aetna and BUCA both have a range of $1.00, and Blue Cross Blue Shield has a range of $2.67.
The table and chart below present the full breakdown of national benchmarks for each payer.
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