CPT 86902 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 | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 26 - Professional component 91 - Repeat Lab Test |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86902 |
National average reimbursement for CPT 86902 by major payers:
$5.02
$3.57
$7.61
$31.20
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 86902 | $2.67 | 1609005479 - WILLIAM YANG | 953841576 - (CA) RENAL CONSULTANTS MEDICAL GROUP | CA | Nephrology Physician (207RN0300X) |
United | 86902 | $2.69 | 1619910627 - BRADLEY WEISNER | 562107759 - UROLOGY SPECIALISTS OF THE CAROLINAS, PLLC | NC | Urology Physician (208800000X) |
United | 86902 | $3.23 | 1073638490 - SHARRON ACOSTA M.D.P.A. | 742979530 - SHARRON ACOSTA, M.D., P.A. | TX | Ophthalmology Physician (207W00000X) |
United | 86902 | $3.81 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 86902 | $2.26 | 1730106824 - NEVADA EYE CARE PROFESSIONALS LITTLE & STEIN, LTD. | 880316581 - NEVADA EYE CARE PROFESSIONALS | NV | Single Specialty Group (193400000X) |
United | 86902 | $9.53 | 1003166612 - MATTHEW LILLEY | 680637976 - BEND MEMORIAL CLINIC, PC | OR | Orthopaedic Surgery Physician (207X00000X) |
United | 86902 | $3.23 | 1013068808 - ST HELENA PARISH HOSPITAL, ST HELENA PARISH HOSPITAL | 720627145 - (LA) ST HELENA PARISH HOSPITAL | LA | Critical Access Hospital (282NC0060X) |
United | 86902 | $6.35 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 86902 | $5.08 | 1164776688 - NICOLE SCHWAB | 362925195 - ALLERGY & ASTHMA OF DUPAGE, S.C. | IL | Family Nurse Practitioner (363LF0000X) |
United | 86902 | $2.98 | 1164776688 - NICOLE SCHWAB | 362925195 - ALLERGY & ASTHMA OF DUPAGE, S.C. | IL | Family Nurse Practitioner (363LF0000X) |
United | 86902 | $6.48 | 1891731998 - AHS HOSPITAL CORP., MORRISTOWN MEDICAL CENTER | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Psychiatric Hospital Unit (273R00000X) |
United | 86902 | $2.67 | 1851464549 - PROGRESSIVE MEDICAL CENTER SC | 363950044 - PROGRESSIVE MEDICAL CENTER, S.C. | IL | Internal Medicine Physician (207R00000X) |
United | 86902 | $8.38 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 86902 | $2.67 | 1144370990 - ROLANDO HENRIQUEZ | 363950044 - PROGRESSIVE MEDICAL CENTER, S.C. | IL | Internal Medicine Physician (207R00000X) |
United | 86902 | $2.67 | 1073515912 - MARK VITAL | 760512625 - HEA CLINIC, P.A. | TX | Ophthalmology Physician (207W00000X) |
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 86902 vs. Other Transfusion Medicine Procedures Codes
The CPT 86902 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 86902 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 |
|---|---|---|
| 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. |
| 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. |
| 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). |
| 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. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86902. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86902 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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