Summary & Overview
CPT 86901: Blood Typing, Serologic (Rh) Procedure
CPT code 86901 is a widely used billing code for blood typing, specifically serologic testing for Rh factor. This procedure is a cornerstone in transfusion medicine, ensuring compatibility between donor and recipient blood types and preventing adverse reactions. The code is recognized nationally and is covered by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
This publication provides a comprehensive overview of 86901, detailing its clinical significance, typical laboratory settings, and its role in pathology and laboratory procedures. Readers will gain insights into payer coverage, relevant benchmarks, and recent policy updates affecting reimbursement and utilization. The analysis also highlights associated modifiers and taxonomies, as well as common ICD-10 diagnoses linked to Rh blood typing.
Healthcare professionals, laboratory managers, and policy analysts will find this summary useful for understanding the national landscape of blood typing services, including payer trends and clinical context. The information is organized to support decision-making and awareness of current standards in transfusion medicine.
CPT Code Overview
CPT code 86901 represents blood typing; serologic (e.g., Rh). This procedure is classified under Pathology and Laboratory Procedures, specifically within Transfusion Medicine Procedures. It is typically performed in a laboratory setting such as Place of Service 19 or 81. The test is essential for determining a patient's Rh blood group, which is critical for safe transfusion practices and clinical decision-making.
Clinical & Coding Specifications
Clinical Context
A patient presents to a healthcare facility requiring blood transfusion or preoperative assessment. As part of the transfusion medicine workflow, a blood sample is collected and sent to the laboratory. The laboratory performs serologic blood typing to determine the patient's Rh status using procedure 86901 – Blood typing; serologic (e.g., Rh). This information is critical for ensuring compatibility with donor blood and preventing transfusion reactions. The procedure is typically performed in a laboratory setting (Place of Service 19 or 81) by a specialist or technologist in pathology.
Coding Specifications
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Modifiers:
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26: Professional Component. Used when only the interpretation of the blood typing test is performed by the physician or pathologist. - Modifier
TC: Technical Component. Used when only the technical aspect (e.g., specimen processing, test performance) is provided by the laboratory.
- Modifier
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Provider Taxonomies:
Taxonomy Code Specialty Name 246Q00000XSpecialist/Technologist, Pathology
These taxonomies represent providers qualified to perform and interpret laboratory blood typing procedures.
Related Diagnoses
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Z67.00– Type A blood, Rh positive- Indicates the patient has type A blood with Rh positive status, relevant for documenting the result of the Rh typing procedure.
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Z67.10– Type B blood, Rh positive- Indicates the patient has type B blood with Rh positive status, relevant for Rh typing.
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Z67.20– Type AB blood, Rh positive- Indicates the patient has type AB blood with Rh positive status, relevant for Rh typing.
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Z67.30– Type O blood, Rh positive- Indicates the patient has type O blood with Rh positive status, relevant for Rh typing.
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Z67.40– Type A blood, Rh negative- Indicates the patient has type A blood with Rh negative status, relevant for Rh typing.
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Z67.50– Type B blood, Rh negative- Indicates the patient has type B blood with Rh negative status, relevant for Rh typing.
Each diagnosis code documents the specific blood type and Rh status determined by the procedure 86901.
Related CPT Codes
86900– Blood typing, serologic (e.g., ABO)
86900 is used for serologic determination of the ABO blood group. It is commonly performed alongside 86901 to establish both ABO and Rh status for transfusion compatibility. Both codes may be used together in a clinical workflow when a complete blood type is required. 86900 and 86901 are not alternatives but complementary procedures.
National Reimbursement Benchmarks
For CPT code 86901, national mean rates among commercial payers show that Cigna has the highest average reimbursement at $5.74, while UnitedHealth Group is the lowest at $2.63. The BUCA (average commercial) mean rate is $3.73, which is notably higher than UnitedHealth Group and Aetna, but lower than Cigna. Medicare rates are not available in the input for comparison.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. UnitedHealth Group exhibits the tightest range at $2.00, indicating less variability in rates, while Blue Cross Blue Shield has the widest range at $2.33. Cigna and BUCA also show moderate dispersion, with ranges of $2.33 and $1.63, respectively. This suggests that Blue Cross Blue Shield and Cigna have more variability in their national reimbursement rates for this code.
The table and chart below present the full breakdown of national benchmarks for CPT code 86901 across major commercial payers.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.