CPT 86886 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Transfusion Medicine Procedures |
| Common Place of Service | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | None 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86886 |
National average reimbursement for CPT 86886 by major payers:
$4.68
$3.79
$6.19
$7.90
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 86886 | $782.16 | 1437605532 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CENTER FOR PEDIATRIC MED | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 86886 | $5.17 | 1932284411 - FOUNDATION BARIATRIC HOSPITAL OF SAN ANTONIO, LLC, FOUNDATION SURGICAL HOSPITAL OF SAN ANTONIO | 203793927 - (TX) FOUNDATION BARIATRIC HOSPITAL OF SAN ANTONIO, LLC | TX | General Acute Care Hospital (282N00000X) |
United | 86886 | $6.15 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 86886 | $35.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 86886 | $3.11 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 86886 | $6.84 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 86886 | $7.09 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | 86886 | $7.77 | 1003166612 - MATTHEW LILLEY | 680637976 - BEND MEMORIAL CLINIC, PC | OR | Orthopaedic Surgery Physician (207X00000X) |
United | 86886 | $4.40 | 1235685892 - FAIRFIELD HOSPITAL DISTRICT, FREESTONE MEDICAL CENTER | 741774669 | TX | General Acute Care Hospital (282N00000X) |
United | 86886 | $5.17 | 1144203662 - TOPS SPECIALTY HOSPITAL, LTD., TOPS SURGICAL SPECIALTY HOSPITAL | 760246499 - (TX) TOPS SPECIALTY HOSPITAL LTD | TX | General Acute Care Hospital (282N00000X) |
United | 86886 | $3.11 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 86886 | $5.17 | 1306897277 - COLUMBIA MEDICAL CENTER OF DENTON SUBSIDIARY LP, MEDICAL CITY DENTON | 621682213 - (TX) COLUMBIA MEDICAL CENTER OF DENTON SUBSIDIARY LP | TX | General Acute Care Hospital (282N00000X) |
United | 86886 | $782.16 | 1417505694 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH HILLCREST HOSPITAL VASCULAR LAB | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 86886 | $5.17 | 1982800397 - PELHAM MEDICAL CENTER | 141996067 | SC | General Acute Care Hospital (282N00000X) |
United | 86886 | $3.11 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 86886 vs. Other Transfusion Medicine Procedures Codes
The CPT 86886 code is part of the Pathology and Laboratory Procedures services used for Transfusion Medicine 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 86886 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 |
|---|---|---|
| 86850-CPT | Low | Blood Autoimmune Test, This Blood Test Checks For The Presence Of Immune Cells (Antibodies) That React To Red Blood Cells As If They Were Harmful. The Test Is Done Prior To Giving A Blood Transfusion Or Childbirth. |
| 86870-CPT | Low | Blood Autoimmune Test, This Blood Test Checks For The Presence Of Immune Cells (Antibodies) That React To Red Blood Cells As If They Were Harmful. The Test Is Done Prior To Giving A Blood Transfusion. |
| 86880-CPT | Low | Antihuman Globulin Test (Coomb, Antihuman Globulin Test (Coombs Test) Direct Eachantiserum (Closest Clinically Equivalent Code(S)Deleted In 1993 86031 86034) |
| 86886-CPT | Low | Coombs Blood Test, The Coombs Test Detects Antibodies To Red Blood Cells. These Are Common With Anemia And May Cause A Reaction To A Blood Transfusion. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86886. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86886 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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