CPT 86904: Donor Unit Serum with Recipient Serum Crossmatch Screen
Commercial payers pay $25 on average nationally for this procedure.
CPT code 86904 describes a laboratory crossmatch screening test in which a portion of a donor blood unit is mixed with the recipient patient’s serum to detect potential reactive antigens; this is a blood compatibility screening service performed by a laboratory analyst, typically classified as a clinical laboratory procedure and usually provided in a hospital blood bank or clinical laboratory setting.
For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Antibody-Drug Conjugates, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only).
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National Reimbursement Benchmarks
National commercial reimbursement for CPT 86904 centers near BUCA’s average commercial rate of $24.8, with notable variation across major payers. Blue Cross Blue Shield has the highest mean at $34 and a wide upper tail; Cigna and UnitedHealth Group cluster lower, with mean rates of $14.5 and $12.9 respectively, while Aetna posts the lowest mean of $10.2. BUCA’s median of $22.8 aligns close to its mean, indicating moderate symmetry around that average.
Dispersion measured by the interquartile range (P75–P25) highlights payer variability: Blue Cross Blue Shield is the widest with a spread of $15.2, reflecting broader commercial contracting outcomes, while Aetna is the tightest with a spread of $6.0. Cigna’s IQR is $12.8, UnitedHealth Group’s is $9.4, and BUCA’s is $13.6, so payers fall across a sizable continuum from relatively tight to substantially dispersed commercial rates.