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CPT 86904: Donor Unit Screening with Recipient Serum for Reactive Antigens
CPT code 86904 covers a laboratory immunohematology screening procedure that tests potential donor blood units by mixing donor material with recipient serum to identify possible reactive antigens. This test is a critical step in ensuring transfusion compatibility and patient safety across hospital blood banks and clinical laboratories nationwide. The code is relevant to hospitals, transfusion services, and independent laboratories that perform pre-transfusion compatibility testing.
Key payers included in this national overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for 86904, its typical service settings, and how it relates to other blood typing and antigen-screening procedures. The publication summarizes payer coverage patterns, common billing considerations, and coding relationships to adjacent procedures such as ABO and Rh typing and antigen screening.
This summary equips billing managers, laboratory directors, and policy analysts with a clear description of what CPT code 86904 represents, why it matters for transfusion safety, and where it fits within the laboratory service line. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 86904 describes a laboratory screening procedure in which a lab analyst uses serum from a recipient patient to test a potential donor blood unit for possible reactive antigens. The service involves mixing part of the donor unit with recipient serum to detect antigen-antibody reactions that could affect transfusion compatibility.
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Service type: Laboratory immunohematology screening
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Typical site of service: Hospital laboratory, blood bank, or independent clinical laboratory
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.