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See a sample rate comparisonCPT 86904 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 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 | 26 - Professional component 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $16.34 national lab fee schedule rate (2026) · View Medicare rates for 86904 |
| Medicaid Fee Schedule | $15.03 median of the 8 states in the free preview · View Medicaid rates for 86904 |
National average reimbursement for CPT 86904 by major payers:
$12.89
$9.06
$15.22
$23.05
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CPT 86904
5 of 25 sample ratesHigher to lower in this preview
Prisma Health-Upstate, Prisma Health Ctr For Ped & Int Med-West
Prisma Health - Upstate
$271.10Published rateLaredo Texas Hospital Company Lp, Laredo Medical Center
$44.90Published rateChristopher Raio
St Francis Hospital
$19.41Published rateBaycare Home Care, Inc., Dba Sarasota Memorial Home Care
Baycare Home Care Inc
$9.61Published rateMolly Mcintosh
Baycare Medical Group Inc
$5.48Published rate
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See a sample payer proposalCPT 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 |
|---|---|---|
| 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. |
| 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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