What factors affect fee schedules?

Fee schedules are affected by several factors including Medicare & Medicaid Rates, which are government-set reimbursement amounts; Private Insurance Rates, which are negotiated between providers and insurance companies; Geographic Location, as costs may be higher in urban areas; and Provider Type, as hospital providers may have different rates than private practices.

How can I find out the cost of a medical procedure or service?

To find the cost of a medical procedure or service, you often need to know the specific CPT code (Current Procedural Terminology) for that service and your geographic location. Healthcare costs can vary significantly based on provider, facility, insurance plan, and region. For specific pricing, you can use tools like Payerprice, which allows you to search with a CPT code and location. It's also recommended to contact your insurance provider directly or the healthcare facility for an estimate.

What is a CPT code, and why is it important for understanding medical costs?

A CPT (Current Procedural Terminology) code is a five-digit numerical code used by healthcare providers to describe medical, surgical, and diagnostic services. These codes are essential for standardizing billing and record-keeping in healthcare. When trying to understand medical costs, knowing the CPT code for a specific service allows you to get accurate pricing information from providers, insurance companies, or pricing lookup tools like Payerprice, as costs are typically tied to these codes.

Where can I find a fee schedule for medical services?

Fee schedules are lists of prices for medical procedures and services. While some general fee schedules might be available, specific pricing for your situation will depend on your location, the provider, and your insurance plan. For detailed fee schedule information tailored to specific CPT codes and your location, you can utilize tools such as Payerprice, which offers a fee schedule lookup tool. Your insurance company can also provide a personalized fee schedule based on your plan's negotiated rates.

Why do medical costs vary so much for the same procedure?

Medical costs for the same procedure can vary significantly due to several factors, including: Geographic location, healthcare provider and facility, insurance negotiations, type of service, and technology and equipment used. Tools like Payerprice can help you compare costs for specific CPT codes across different locations and providers.

How does Payerprice help me find healthcare costs, and how does it compare to CMS data?

Payerprice offers a fee schedule lookup tool that allows users to search for healthcare costs using CPT codes and specific locations. This tool provides granular, localized pricing information. While CMS (Centers for Medicare & Medicaid Services) publishes extensive data, including Medicare's fee schedules, Payerprice is designed to provide more comprehensive, commercial insurance-specific, and localized data, which is often more relevant for individuals with private insurance or seeking market rates. Payerprice's tool simplifies the process of finding specific, actionable price estimates that go beyond just Medicare rates.

Is there a fee to use Payerprice's fee schedule lookup tool?

Yes, Payerprice has its own fee schedule lookup tool for users to search with CPT codes and specific locations, which typically involves a fee. Details regarding pricing and subscription models would be available directly on the Payerprice website.

CPT 86901 Fee Schedule

Last Verified: September 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.

Rh Blood Typing, This Test Refines Basic Ab0 Blood Typing Prior To Giving A Transfusion. If Rh (D) Antigens Are Present The Blood Is Typed + (Positive) And If Not The Blood Is Rh- (Negative).

Check Rates

Key Fact	Detail
Service Type	Pathology and Laboratory Procedures Transfusion Medicine Procedures
Common Place of Service	21 - Inpatient Hospital 81 - Independent Laboratory
Common Modifiers	None 26 - Professional component TC - Technical component
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 86901
Medicaid Fee Schedule	View Medicaid rates for 86901

National average reimbursement for CPT 86901 by major payers:

$2.69

$2.44

$3.96

$4.61

CPT 86901 vs. Other Transfusion Medicine Procedures Codes

The CPT 86901 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 86901 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
86900-CPT	Low	Blood Typing, This Test Combines A Sample Of Whole Blood With Types 0 A B And Ab. By Observing Which Combinations Cause Blood Cells To Clump A Technician Can Match The Sample To A Type. The Test Is Done Before Giving A Transfusion. Check Rates
86901-CPT	Low	Rh Blood Typing, This Test Refines Basic Ab0 Blood Typing Prior To Giving A Transfusion. If Rh (D) Antigens Are Present The Blood Is Typed + (Positive) And If Not The Blood Is Rh- (Negative). Check Rates
86902-CPT	Low	Donor Blood Typing, Before A Transfusion Blood Must Be Matched Between Donor And Recipient. Donor Blood Is Typed Prior To Storage By Adding A Substance To A Small Sample Of The Blood. The Blood Is Checked Again Before Being Given In A Transfusion. Check Rates
86904-CPT	Low	Blood Typing For A Match, Before A Transfusion Blood Is Checked To Ensure A Match Between Donor And Recipient. The Testing Can Be Done By Adding A Substance To The Recipients Blood Sample Or By Mixing The Sample With A Small Amount Of Donor Blood. Check Rates

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86901. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 86901 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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