CPT 86923 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 86923 |
| Medicaid Fee Schedule | View Medicaid rates for 86923 |
National average reimbursement for CPT 86923 by major payers:
$23.75
$15.75
$23.77
$56.11
CPT 86923 vs. Other Transfusion Medicine Procedures Codes
The CPT 86923 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 86923 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 |
|---|---|---|
| 86923-CPT | Low | Test For Blood Match, Before Transfusion Donor Blood Is Checked For Compatibility With The Recipient. This Is A Routine Test To Ensure Ab0 Combinations Between Donor And Recipient Do Not Provoke An Immune Reaction. If Information Is On File The Match May Be Done Electronically. |
| 86927-CPT | Low | Plasma Thawing Services, Blood And Blood Products Are Frozen For Long-Term Storage. Each Unit Is Thawed Only As It Is Needed. |
| 86945-CPT | Low | Irradiation Of Blood Product, Irradiation Of Blood Product Each Unit (Closest Clinically Equivalent Code(S) Deleted In 1993 86342) |
| 86999-CPT | High | Transfusion Procedure, Transfusion Of One Or More Units Of Blood Or Blood Product. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86923. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86923 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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