Summary & Overview
CPT 86904: Blood typing, patient serum
Headline: CPT 86904: Blood typing on patient serum — key test for transfusion safety
Lead: CPT 86904 designates blood typing performed on patient serum to identify blood group antigens and guide transfusion and blood bank decisions. This common laboratory procedure underpins safe transfusion practice and routine pre-transfusion assessment nationwide.
What the code represents and why it matters: CPT 86904 documents a core blood bank service — serum-based blood typing — used in clinical pathways for transfusion compatibility, preoperative evaluation, and diagnostic workups. Accurate blood typing reduces risk of hemolytic reactions and supports inventory management in hospital and outpatient settings.
Key payers covered: The analysis addresses coverage considerations across major commercial payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
What readers will learn: This publication provides a concise overview of the clinical context for CPT 86904, common billing relationships within transfusion medicine, typical sites of service, and how this code relates to adjacent blood typing and antigen testing codes. It summarizes applicable ICD-10 encounter scenarios and highlights administrative elements relevant to billing and claims processing. Data not available in the input is noted where applicable.
Intended audience: Laboratory administrators, billing professionals, transfusion medicine clinicians, and policy analysts seeking a focused reference on the role and billing context of CPT 86904.
CPT Code Overview
CPT 86904 is a laboratory test that performs blood typing on patient serum to determine the patient’s blood group characteristics. The procedure is part of clinical evaluation for transfusion planning, compatibility assessment, and routine blood bank work.
Service Type: Transfusion Medicine / Pathology and Laboratory Procedures
Typical Site of Service: Independent Laboratory (POS 81)
Clinical & Coding Specifications
Clinical Context
A patient presents to an independent laboratory or transfusion service for pretransfusion testing or routine blood typing. A typical scenario is a physician order for blood type determination prior to elective surgery, pregnancy-related testing, or when establishing baseline blood type in a new patient. Specimen collection is performed by phlebotomy, and the patient serum is sent to the laboratory. In the laboratory, technologists perform serologic testing to determine ABO and Rh characteristics using the patient serum. Results are reported in the electronic medical record and communicated to the ordering clinician to guide transfusion decisions, pregnancy management, or medical record documentation.
Coding Specifications
Modifier 26 and modifier TC indicate components of service for laboratory tests when billed separately. Use of these modifiers depends on billing arrangements between the performing laboratory and the ordering/provider entity.
-
Modifier
26: Professional Component — Used when billing for the professional component of the service (interpretation or professional work) performed by a qualified professional. -
Modifier
TC: Technical Component — Used when billing for the technical component of the service (laboratory processing, equipment, and technician time) when no professional component is billed by the performing entity.
Provider Taxonomies and Specialties
| Taxonomy Code | Specialty |
|---|---|
291U00000X | Clinical Medical Laboratory |
207ZP0102X | Pathology |
207Q00000X | Family Medicine Physician |
Related Diagnoses
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Z01.83— Encounter for blood typingThis code documents a clinical encounter where the primary purpose is determination of blood type; it directly indicates the clinical reason for performing
86904. -
Z67.10— Type A blood, Rh positiveIndicates the patient’s documented blood group and Rh status; result that may be produced by testing with
86904. -
Z67.20— Type B blood, Rh positiveIndicates the patient’s documented blood group and Rh status; result that may be produced by testing with
86904. -
Z67.30— Type AB blood, Rh positiveIndicates the patient’s documented blood group and Rh status; result that may be produced by testing with
86904. -
Z67.40— Type O blood, Rh positiveIndicates the patient’s documented blood group and Rh status; result that may be produced by testing with
86904.
Related CPT Codes
| CPT Code | Description | Clinical Relationship |
|---|---|---|
86900 | Blood typing, ABO | Often performed alongside or prior to 86904 to establish ABO group when serum testing is part of the overall typing panel. Can be complementary in pretransfusion testing. |
86901 | Blood typing, Rh (D) | Complements 86904 by specifically assessing Rh (D) antigen status; commonly used together in transfusion workups. |
86903 | Blood typing, antigen screen | Used in the broader pretransfusion testing workflow to screen for atypical antibodies; may be ordered in conjunction with serum typing. |
86905 | Blood typing, RBC antigens | Provides extended red cell antigen typing beyond basic ABO/Rh and may be ordered when more detailed antigen information is needed; used as an adjunct or follow-up to 86904. |
86906 | Blood typing, Rh phenotype | Provides Rh phenotype details beyond Rh (D) and may be used when more specific Rh characterization is required; can be an alternative or addition to 86904 in complex cases. |
Common usage notes: 86900 and 86901 are commonly used together with 86904 as components of standard pretransfusion serologic testing. 86903, 86905, and 86906 are used as extensions of the typing/screening process when additional antigen or phenotype information is clinically indicated.
National Reimbursement Benchmarks
National commercial averages sit above Medicare for this CPT, with BUCA (the aggregated commercial benchmark) at a mean rate of $13.62 compared with Medicare at $0.00 in the provided input. The largest commercial mean is Cigna at $16.64, while Aetna and UnitedHealth Group are lower at $11.49 and $12.71, respectively.
Dispersion measured as the interquartile range (P75 − P25) is widest for Cigna (14.00), indicating the largest spread between typical lower and upper quartile rates, followed by BCBS (5.00) and BUCA (6.86). The tightest distributions are Aetna (4.44) and UnitedHealth Group (7.00). The table and chart below present the full breakdown.
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