CPT 86960 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 81 - Independent Laboratory |
| Common Modifiers | None 26 - Professional component TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 86960 |
| Medicaid Fee Schedule | View Medicaid rates for 86960 |
National average reimbursement for CPT 86960 by major payers:
$41.27
$17.84
$27.98
$61.96
CPT 86960 vs. Other Transfusion Medicine Procedures Codes
The CPT 86960 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 86960 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 |
|---|---|---|
| 86950-CPT | Low | Leukocyte Transfusion |
| 86960-CPT | Low | Blood Volume Reduction, Blood Volume Reduction Addresses Certain Conditions That Cause The Body To Produce Too Much Blood. Treatment Of Other Conditions Can Involve Manually Reducing The Amount Of A Particular Blood Component Such As Platelets. |
| 86965-CPT | Low | Pooling Of Platelets Or Other, Pooling Of Platelets Or Other Blood Products (Closestclinically Equivalent Code(S) Deleted In 199386404) |
| 86970-CPT | Low | Blood Pretreatment For Test, Before Running A Test Or Identifying Substances A Blood Sample Is Treated. This Can Involve Mixing The Blood With A Dye Drug Or Preservative. Sometimes The Mixture Incubates Until A Necessary Pretest Reaction Occurs. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 86960. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 86960 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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