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See a sample rate comparisonCPT 86940 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.
Bacterial By-Product Test, This Test Checks For The Presence Of Substances That Form When Bacteria Are Present In The Blood: Hemolysins And Agglutinins. Hemolysins Cause Red Blood Cells To Fall Apart. Agglutinins Make The Cells Clump Together.
| 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 PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
| Medicare Fee Schedule | $8.77 national lab fee schedule rate (2026) · View Medicare rates for 86940 |
| Medicaid Fee Schedule | $8.66 median of the 8 states in the free preview · View Medicaid rates for 86940 |
National average reimbursement for CPT 86940 by major payers:
$7.82
$5.96
$11.39
$12.75
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CPT 86940
5 of 25 sample ratesHigher to lower in this preview
Restorative Health Rehabilitation Inc
$35.00Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$11.24Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$8.77Published rateChristopher Raio
Mercy Medical Center
$5.26Published rateAaron Askew
The Orthopedic And Neurosurgical Center Of The Cascades
$3.68Published rate
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See a sample payer proposalCPT 86940 vs. Other Transfusion Medicine Procedures Codes
The CPT 86940 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 86940 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 |
|---|---|---|
| 86930-CPT | Low | Frozen Blood Preparation For, Frozen Blood Preparation For Freezing Each Unit(Closest Clinically Equivalent Code(S) Deleted I N 1993 86265) |
| 86931-CPT | Low | Frozen Blood Preparation For, Frozen Blood Preparation For Freezing Each Unitwiththawing (Closest Clinically Equivalent Code(S ) Deleted In 1993 86266) |
| 86940-CPT | Low | Bacterial By-Product Test, This Test Checks For The Presence Of Substances That Form When Bacteria Are Present In The Blood: Hemolysins And Agglutinins. Hemolysins Cause Red Blood Cells To Fall Apart. Agglutinins Make The Cells Clump Together. |
| 86941-CPT | Low | Bacterial By-Product Test, This Test Checks For The Presence Of Substances That Form When Bacteria Are Present In The Blood: Hemolysins And Agglutinins. Hemolysins Cause Red Blood Cells To Fall Apart. Agglutinins Make The Cells Clump Together. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86940. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86940 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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