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    v1.0.30
    OpenPayerBilling CodesTransfusion Medicine ProceduresCPT cpt-86901-rh-blood-group-typing-serologic-plasma-serum
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    CPT 86901: Rh Blood Group Serologic Typing, Serum/Plasma

    Commercial payers pay $11 on average nationally for this procedure.

    CPT code 86901 describes a serologic test performed by a laboratory analyst to determine a patient’s blood type within the Rh blood group system using serum or plasma; this is a blood typing service typically performed in a clinical laboratory or hospital laboratory setting for transfusion compatibility and diagnostic purposes.

    For related coverage guidance, see recent payer policy updates: Hematology - Adzynma, Tumor Treating Fields for Pancreatic Cancer, Axicabtagene ciloleucel (Yescarta®) coverage.

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    National Reimbursement Benchmarks

    Commercial reimbursement for CPT 86901 centers around BUCA’s average commercial rate of $10.5, with notable variation across major national payers. Blue Cross Blue Shield shows the highest central tendency (median $15.1) and a wide upper bound (90th percentile $23.0), while Aetna and Cigna present much lower central values (medians $2.3 and $3.3 respectively). Cigna’s maximum is $13.1 and UnitedHealth Group’s median is $1.8, reflecting differing network pricing strategies.

    Examining dispersion (P75 minus P25) highlights where rates cluster or diverge: Blue Cross Blue Shield has the widest interquartile spread at $7.0 ($19.2 − $12.2), indicating more variability in contracted rates, while UnitedHealth Group is the tightest at $1.7 ($3.0 − $1.3). Aetna’s spread is $1.7 ($3.7 − $2.0) and Cigna’s is $3.0 ($5.0 − $2.0), placing them between the extremes. BUCA’s quartiles (P75 $12.7, P25 $7.8) imply a moderate spread of $4.9 without min/max reporting.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Clinical & Coding Specifications

    Clinical Context

    A 28-year-old pregnant woman presents to the outpatient laboratory for routine prenatal testing at 28 weeks gestation. A phlebotomy technician collects serum or plasma and sends the specimen to the hospital pathology laboratory. A technologist or specialist in the Pathology taxonomy performs serologic testing to determine the patient’s Rh blood group (for example, identifying Rh positive or Rh negative) using 86901. Results are documented in the laboratory information system and communicated to the obstetrics provider to guide Rh immunoprophylaxis decisions and transfusion planning if needed. Typical sites of service include hospital outpatient laboratories, independent clinical laboratories, and inpatient hospital laboratories when preoperative or transfusion planning is required.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    86900Blood typing, serologic (e.g., ABO)Commonly performed alongside 86901 to determine ABO group; both tests inform transfusion compatibility and prenatal risk assessment

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    90Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
    91Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    246Q00000X
    2083B0002X
    2080P0008X
    174V00000X
    282NR1301X
    163WN0002X
    261Q00000X
    246QM0706X

    Related ICD-10-CM Codes

    33 rows

    ICD-10-CM CodeDescription
    D50.9Iron deficiency anemia, unspecified
    D55.9Anemia due to enzyme disorder, unspecified
    D56.9Thalassemia, unspecified
    D67Hereditary factor IX deficiency
    I10Essential (primary) hypertension
    I21.9Acute myocardial infarction, unspecified
    N39.0Urinary tract infection, site not specified
    O36.0120Maternal care for anti-D [Rh] antibodies, second trimester, not applicable or unspecified
    O36.0121Maternal care for anti-D [Rh] antibodies, second trimester, fetus 1
    O36.0122Maternal care for anti-D [Rh] antibodies, second trimester, fetus 2

    Showing 1–10 of 33

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    Hematology - AdzynmaCigna2026-10-15
    Tumor Treating Fields for Pancreatic Cancerselect_health2026-10-01
    Axicabtagene ciloleucel (Yescarta®) coverageBaylor Scott & White Health Plan2026-10-01
    Electric Tumor Treatment Field Therapy (for Kentucky Only)UnitedHealthcare2026-10-01
    Electric Tumor Treatment Field Therapy (for Kansas Only)UnitedHealthcare2026-10-01
    Electric Tumor Treatment Field Therapy (for Idaho Only)UnitedHealthcare2026-10-01
    Brexucabtagene autoleucel (Tecartus) CoverageBaylor Scott & White Health Plan2026-10-01
    Electric Tumor Treatment Field Therapy (for Pennsylvania Only)UnitedHealthcare2026-10-01
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Factor VIII ProductsCigna2026-09-15

    Related Codes

    CPT-86850-RBC-ANTIBODY-SCREENING

    CPT 86850: Screening Test for Non‑A/B Red Blood Cell Antibodies

    CPT-86860-RBC-ELUTION-IMMUNOHEMATOLOGY-BLOOD-BANK

    CPT 86860: RBC Elution for Antibody Detection

    CPT-86870-RBC-ANTIBODY-IDENTIFICATION-IMMUNOHEMATOLOGY

    CPT 86870: Antibody Identification to Red Blood Cells

    CPT-86880-DIRECT-ANTIGLOBULIN-TEST-DAT-COOMBS

    CPT 86880: Direct Antihuman Globulin (Coombs) Test

    CPT-86885-INDIRECT-ANTIGLOBULIN-COOMBS-TEST

    CPT 86885: Indirect Antiglobulin (Coombs) Test for Serum Antibodies

    CPT-86886-INDIRECT-ANTIGLOBULIN-COOMBS-TEST-SERIAL-DILUTIONS

    CPT 86886: Indirect Antihuman Globulin (Coombs) Test

    CPT-86890-AUTOLOGOUS-BLOOD-COLLECTION-PROCESSING-STORAGE

    CPT 86890: Autologous Blood Collection, Processing, and Storage

    CPT-86891-INTRAOPERATIVE-BLOOD-SALVAGE-AUTOTRANSFUSION

    CPT 86891: Intraoperative Blood Salvage (Cell Salvage)

    CPT-86900-ABO-BLOOD-TYPING-SERUM-PLASMA

    CPT 86900: ABO Blood Typing Using Serum or Plasma

    CPT-86902-ANTIGEN-SCREENING-DONOR-BLOOD-UNIT

    CPT 86902: Antigen Screen of Donor Blood Unit

    Showing 1–10 of 38

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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