Summary & Overview
CPT 86905: Blood Typing for RBC Antigens Other Than ABO or Rh(D)
CPT code 86905 represents blood typing for red blood cell antigens other than ABO or Rh(D), a critical laboratory service in transfusion medicine and prenatal care. This procedure is performed to identify less common RBC antigens, which is vital for ensuring compatibility in blood transfusions and for managing pregnancies where antigen mismatches may pose risks. Nationally, this code is widely utilized in clinical laboratories and hospital outpatient settings, reflecting its importance in both routine and specialized patient care.
Major payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication provides an overview of payer coverage, policy updates, and clinical context for 86905, helping readers understand how this code is used across the healthcare landscape. Key benchmarks and trends in reimbursement, as well as relevant clinical scenarios, are discussed to inform stakeholders about the evolving role of blood typing beyond ABO and Rh(D).
Readers will gain insights into the significance of 86905 in laboratory medicine, its impact on patient safety, and how payer policies shape access to this essential service. The summary also highlights related codes and modifiers, offering a comprehensive view of blood typing procedures and their place in modern healthcare.
CPT Code Overview
CPT code 86905 is used to report blood typing procedures for red blood cell (RBC) antigens other than ABO or Rh(D). This laboratory service is essential in blood banking and transfusion medicine, supporting safe transfusion practices and prenatal care. The procedure is typically performed in a clinical laboratory setting (Place of Service 81) or a hospital outpatient facility (Place of Service 19). Identifying RBC antigens beyond the common ABO and Rh(D) types helps prevent transfusion reactions and supports comprehensive patient care.
Clinical & Coding Specifications
Clinical Context
A patient presents to a clinical laboratory or hospital outpatient setting for blood typing as part of antenatal screening during pregnancy. The laboratory is requested to identify red blood cell (RBC) antigens other than ABO or Rh(D) to assess compatibility for potential transfusion or to screen for hemolytic disease of the newborn. The workflow involves collecting a blood sample, performing laboratory analysis to detect specific RBC antigens, and reporting the results to the ordering provider, typically an obstetrician or family medicine physician overseeing prenatal care.
Coding Specifications
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Modifiers:
- Modifier
26: Used when reporting only the professional component of the laboratory service, such as interpretation of results by a pathologist. - Modifier
TC: Used when reporting only the technical component, which includes specimen processing and laboratory analysis.
- Modifier
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Provider Taxonomies:
Taxonomy Code Specialty Name 291U00000XClinical Medical Laboratory 207ZP0102XPathology 207Q00000XFamily Medicine Physician
These taxonomies represent the clinical laboratory performing the test, the pathologist interpreting results, and the family medicine physician ordering or overseeing the procedure.
Related Diagnoses
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Z34.00— Encounter for supervision of normal first pregnancy, unspecified trimester- Relevant for routine antenatal screening, including blood typing for transfusion risk assessment.
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Z34.80— Encounter for supervision of other normal pregnancy, unspecified trimester- Used for ongoing prenatal care in subsequent pregnancies, where blood typing may be indicated.
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Z32.01— Encounter for pregnancy test, result positive- Indicates a newly confirmed pregnancy, often prompting initial blood typing and screening.
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Z36.0— Encounter for antenatal screening for chromosomal anomalies- Blood typing may be part of broader antenatal screening protocols.
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Z36.89— Encounter for other specified antenatal screening- Used when blood typing is performed as part of additional antenatal screening procedures.
Related CPT Codes
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86904— Blood typing, patient serum- Used to determine blood group from patient serum; may be performed alongside
86905for comprehensive typing.
- Used to determine blood group from patient serum; may be performed alongside
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86906— Blood typing, Rh phenotype- Identifies specific Rh antigens; complements
86905when detailed Rh typing is needed.
- Identifies specific Rh antigens; complements
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86901— Rh typing- Determines Rh(D) status; often performed prior to or in conjunction with
86905for full antigen profile.
- Determines Rh(D) status; often performed prior to or in conjunction with
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86903— Blood typing, antigen screen- Screens for multiple RBC antigens; may be used as an alternative or in addition to
86905depending on clinical requirements.
- Screens for multiple RBC antigens; may be used as an alternative or in addition to
These codes are commonly used together in blood banking and transfusion medicine workflows to ensure accurate blood compatibility and to screen for potential antigen-related complications.
National Reimbursement Benchmarks
National mean rates for CPT code 86905 show that BUCA (average commercial) payers reimburse at $4.37, which is higher than typical Medicare rates for similar laboratory services. Among individual commercial payers, Cigna stands out with the highest mean rate at $6.57, while UnitedHealth Group and Aetna are at the lower end, both below $3.60.
Rate dispersion varies significantly across payers. UnitedHealth Group has the tightest range, with a difference of $2.00 between the 75th and 25th percentiles, indicating less variability in contracted rates. Cigna exhibits the widest spread, with a $2.50 difference, reflecting greater variability in reimbursement. Blue Cross Blue Shield and BUCA also show moderate dispersion, while Aetna's rates are tightly clustered.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.