Summary & Overview
CPT 86904: Blood typing, patient serum
Headline: CPT 86904: Blood typing on patient serum — key test for transfusion safety
Lead: CPT 86904 designates blood typing performed on patient serum to identify blood group antigens and guide transfusion and blood bank decisions. This common laboratory procedure underpins safe transfusion practice and routine pre-transfusion assessment nationwide.
What the code represents and why it matters: CPT 86904 documents a core blood bank service — serum-based blood typing — used in clinical pathways for transfusion compatibility, preoperative evaluation, and diagnostic workups. Accurate blood typing reduces risk of hemolytic reactions and supports inventory management in hospital and outpatient settings.
Key payers covered: The analysis addresses coverage considerations across major commercial payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
What readers will learn: This publication provides a concise overview of the clinical context for CPT 86904, common billing relationships within transfusion medicine, typical sites of service, and how this code relates to adjacent blood typing and antigen testing codes. It summarizes applicable ICD-10 encounter scenarios and highlights administrative elements relevant to billing and claims processing. Data not available in the input is noted where applicable.
Intended audience: Laboratory administrators, billing professionals, transfusion medicine clinicians, and policy analysts seeking a focused reference on the role and billing context of CPT 86904.
CPT Code Overview
CPT 86904 is a laboratory test that performs blood typing on patient serum to determine the patient’s blood group characteristics. The procedure is part of clinical evaluation for transfusion planning, compatibility assessment, and routine blood bank work.
Service Type: Transfusion Medicine / Pathology and Laboratory Procedures
Typical Site of Service: Independent Laboratory (POS 81)
Clinical & Coding Specifications
Clinical Context
A patient presents to an independent laboratory or transfusion service for pretransfusion testing or routine blood typing. A typical scenario is a physician order for blood type determination prior to elective surgery, pregnancy-related testing, or when establishing baseline blood type in a new patient. Specimen collection is performed by phlebotomy, and the patient serum is sent to the laboratory. In the laboratory, technologists perform serologic testing to determine ABO and Rh characteristics using the patient serum. Results are reported in the electronic medical record and communicated to the ordering clinician to guide transfusion decisions, pregnancy management, or medical record documentation.
Coding Specifications
Modifier 26 and modifier TC indicate components of service for laboratory tests when billed separately. Use of these modifiers depends on billing arrangements between the performing laboratory and the ordering/provider entity.
-
Modifier
26: Professional Component — Used when billing for the professional component of the service (interpretation or professional work) performed by a qualified professional. -
Modifier
TC: Technical Component — Used when billing for the technical component of the service (laboratory processing, equipment, and technician time) when no professional component is billed by the performing entity.
Provider Taxonomies and Specialties