CPT 86904 Fee Schedule

Last Verified: August 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 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.

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 59 - Distinct Procedural Service
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 86904
Medicaid Fee Schedule	View Medicaid rates for 86904

National average reimbursement for CPT 86904 by major payers:

$12.89

$9.06

$15.22

$23.05

Preview provider-level rates for...

For billing codeCPT 86904

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	86904	$9.80	1255478004 - CHRISTOPHER RAIO	208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC	NY	Emergency Medicine Physician (207P00000X)
United	86904	$55.00	1801164967 - DA PEDIATRIC REHABILITATION	270939565 - (FL) DA PEDIATRIC REHABILITATION	FL	Home Health Agency (251E00000X)
United	86904	$19.41	1255478004 - CHRISTOPHER RAIO	113438973 - ST JOSEPH HOSPITAL	NY	Emergency Medicine Physician (207P00000X)
United	86904	$35.95	1073502985 - CHU CHEN	42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.	MA	Pediatrics Physician (208000000X)
United	86904	$9.61	1013915149 - BAYCARE HOME CARE, INC., DBA SARASOTA MEMORIAL HOME CARE	593582520 - (FL) BAYCARE HOME CARE INC	FL	Home Health Agency (251E00000X)
United	86904	$35.95	1073502985 - CHU CHEN	42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.	MA	Pediatrics Physician (208000000X)
United	86904	$5.57	1003192311 - EL CAMPO MEMORIAL HOSPITAL	452750258 - (TX) EL CAMPO MEMORIAL HOSPITAL	TX	General Acute Care Hospital (282N00000X)
United	86904	$5.48	1023438009 - MOLLY MCINTOSH	593140335 - BAYCARE MEDICAL GROUP INC	FL	Home Health Agency (251E00000X)
United	86904	$35.95	1073502985 - CHU CHEN	42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.	MA	Pediatrics Physician (208000000X)
United	86904	$15.93	1225289499 - LUBBOCK HERITAGE HOSPITAL, LLC., GRACE SURGICAL HOSPITAL	264021016 - (TX) LUBBOCK HERITAGE HOSPITAL LLC	TX	General Acute Care Hospital (282N00000X)
United	86904	$8.17	1013068808 - ST HELENA PARISH HOSPITAL, ST HELENA PARISH HOSPITAL	720627145 - (LA) ST HELENA PARISH HOSPITAL	LA	Critical Access Hospital (282NC0060X)
United	86904	$16.34	1295723229 - ST FRANCIS MEDICAL CENTER, INC	720408970 - (LA) ST FRANCIS MEDICAL CENTER INC	LA	General Acute Care Hospital (282N00000X)
United	86904	$8.82	1255478004 - CHRISTOPHER RAIO	111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER	NY	Emergency Medicine Physician (207P00000X)
United	86904	$271.10	1851846661 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CTR FOR PED & INT MED-WEST	811723202 - PRISMA HEALTH - UPSTATE	SC	General Acute Care Hospital (282N00000X)
United	86904	$5.57	1134126659 - CALDWELL MEMORIAL HOSPITAL INC	720878037 - (LA) CALDWELL MEMORIAL HOSPITAL, INC.	LA	General Acute Care Hospital (282N00000X)
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 86904 vs. Other Transfusion Medicine Procedures Codes

The CPT 86904 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 86904 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).
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.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86904. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 86904 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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