Summary & Overview
CPT 86905: Blood Typing for RBC Antigens Other Than ABO or Rh(D)
CPT code 86905 represents blood typing for red blood cell antigens other than ABO or Rh(D), a critical laboratory service in transfusion medicine and prenatal care. This procedure is performed to identify less common RBC antigens, which is vital for ensuring compatibility in blood transfusions and for managing pregnancies where antigen mismatches may pose risks. Nationally, this code is widely utilized in clinical laboratories and hospital outpatient settings, reflecting its importance in both routine and specialized patient care.
Major payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication provides an overview of payer coverage, policy updates, and clinical context for 86905, helping readers understand how this code is used across the healthcare landscape. Key benchmarks and trends in reimbursement, as well as relevant clinical scenarios, are discussed to inform stakeholders about the evolving role of blood typing beyond ABO and Rh(D).
Readers will gain insights into the significance of 86905 in laboratory medicine, its impact on patient safety, and how payer policies shape access to this essential service. The summary also highlights related codes and modifiers, offering a comprehensive view of blood typing procedures and their place in modern healthcare.
CPT Code Overview
CPT code 86905 is used to report blood typing procedures for red blood cell (RBC) antigens other than ABO or Rh(D). This laboratory service is essential in blood banking and transfusion medicine, supporting safe transfusion practices and prenatal care. The procedure is typically performed in a clinical laboratory setting (Place of Service 81) or a hospital outpatient facility (Place of Service 19). Identifying RBC antigens beyond the common ABO and Rh(D) types helps prevent transfusion reactions and supports comprehensive patient care.
Clinical & Coding Specifications
Clinical Context
A patient presents to a clinical laboratory or hospital outpatient setting for blood typing as part of antenatal screening during pregnancy. The laboratory is requested to identify red blood cell (RBC) antigens other than ABO or Rh(D) to assess compatibility for potential transfusion or to screen for hemolytic disease of the newborn. The workflow involves collecting a blood sample, performing laboratory analysis to detect specific RBC antigens, and reporting the results to the ordering provider, typically an obstetrician or family medicine physician overseeing prenatal care.
Coding Specifications
-
Modifiers:
- Modifier
26: Used when reporting only the professional component of the laboratory service, such as interpretation of results by a pathologist. - Modifier
TC: Used when reporting only the technical component, which includes specimen processing and laboratory analysis.
- Modifier
-
Provider Taxonomies:
Taxonomy Code Specialty Name 291U00000X