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See a sample rate comparisonCPT 86078 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Blood Bank Physician Consult, Physician Consultation That Includes An Interpretation And Written Report For Use Of Blood. A Consult Is Requested When There Are Difficulties In Matching The Blood Type Or If The Situation Adds An Unusual Complexity (Such As A Reaction To A Transfusion).
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Immunology Procedures |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | GC - Service performed by resident under supervision 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $51.44 national non-facility rate (2026) · View Medicare rates for 86078 |
| Medicaid Fee Schedule | $42.61 median of the 8 states in the free preview · View Medicaid rates for 86078 |
National average reimbursement for CPT 86078 by major payers:
$60.38
$34.59
$84.21
$51.37
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CPT 86078
5 of 25 sample ratesHigher to lower in this preview
Harvey Schonwald
Phoebe Physician Group Inc
$103.45Published rateMarcus Santana
York Hospital
$33.86Published rateAdam Bulter
$23.64Published rateDavid Alvarez
Tallahassee Orthopedic Clinic III
$23.21Published rateYatin Kheti
Lakeland Regional Health Systems Inc
$16.90Published rate
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See a sample payer proposalCPT 86078 vs. Other Immunology Procedures Codes
The CPT 86078 code is part of the Pathology and Laboratory Procedures services used for Immunology Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 86078 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 86077-CPT | Low | Blood Bank Physician Consult, Physician Consultation That Includes An Interpretation And Written Report For Use Of Blood. A Consult Is Requested When There Are Difficulties In Matching The Blood Type Or If The Situation Adds An Unusual Complexity (Such As A Reaction To A Transfusion). |
| 86078-CPT | Low | Blood Bank Physician Consult, Physician Consultation That Includes An Interpretation And Written Report For Use Of Blood. A Consult Is Requested When There Are Difficulties In Matching The Blood Type Or If The Situation Adds An Unusual Complexity (Such As A Reaction To A Transfusion). |
| 86079-CPT | Low | Blood Bank Physician Consult, Physician Consultation That Includes An Interpretation And Written Report For Use Of Blood. A Consult Is Requested When There Are Difficulties In Matching The Blood Type Or If The Situation Adds An Unusual Complexity (Such As A Reaction To A Transfusion). |
| 86162-CPT | Low | Immune Function Blood Test, The Complement System Is A Group Of Proteins Related To Inflammation That Work With The Immune System. The Blood Complement Test Helps Monitor Progression Of Autoimmune Disease Inflammation And Certain Infections. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86078. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86078 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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