Summary & Overview
CPT 86906: Complete Rh Phenotype Blood Typing
CPT code 86906 represents laboratory testing to determine a patient’s complete Rh phenotype using serum or plasma. This assay identifies Rh antigens and subtypes critical to transfusion medicine, prenatal care, and certain immunohematology evaluations. Nationally, precise Rh phenotyping supports patient safety by guiding blood product selection and preventing alloimmunization.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and common billing considerations for CPT code 86906. The publication outlines national benchmarks where available, typical reimbursement and coverage patterns by major payers, and recent policy or coding clarifications that affect laboratory billing and claim adjudication. Clinical relevance, such as scenarios prompting complete Rh phenotype testing, and operational aspects for laboratories performing the service are summarized.
Data not available in the input for some fields (for example, associated taxonomies, specific ICD-10 mappings, and payer-specific rates) is noted within detailed sections. The content serves as a national, payer-inclusive reference for clinicians, laboratory managers, and billing professionals seeking a clear account of what CPT code 86906 covers and why it matters in clinical practice.
Billing Code Overview
CPT code 86906 describes a laboratory procedure in which a lab analyst determines a patient’s blood type for the complete Rh phenotype using serum or plasma as the specimen. This service involves serologic testing to define Rh antigens and subtypes that are relevant for transfusion compatibility, prenatal assessment, and other clinical situations requiring detailed Rh characterization.
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Service type: Laboratory blood typing for complete Rh phenotype
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Typical site of service: Clinical laboratory or hospital laboratory, performed on serum or plasma specimens
Clinical & Coding Specifications
Clinical Context
A 28-year-old pregnant woman presents for routine prenatal laboratory testing during her first trimester. Her obstetrician orders blood typing and Rh phenotype testing to determine maternal ABO blood group and complete Rh antigen profile using the patient’s serum/plasma. A venous blood sample is collected in an EDTA or serum tube and routed to the hospital blood bank or immunohematology laboratory. The lab analyst performs 86906 testing to identify ABO group and the complete Rh phenotype (including C, c, D, E, e and other relevant Rh antigens) to document maternal alloimmunization risk and to guide antenatal management and transfusion planning if needed. Results are reported in the electronic medical record and communicated to the prenatal care team; if clinically indicated (e.g., history of prior transfusion or inconsistent records), additional confirmatory testing or antibody identification panels may follow.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the professional component of laboratory interpretation is billed separately from the facility/technical component. |
TC |