CPT 86077Laboratory

Phys blood bank serv xmatch

CPT 86077 covers the physician service of reviewing and interpreting blood bank crossmatch testing to ensure a patient receives compatible blood before a transfusion. This is the doctor's professional component of verifying blood compatibility, not the laboratory test itself.

Showing rates for

National Average

Base Medicare rate

$51.11

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.94

PE RVU (NF)

0.6

MP RVU

0.04

Total RVU

1.58

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document physician interpretation time and specific compatibility issues resolved
Impact: Reduces audit risk and supports medical necessity for the $51.11 professional fee, particularly when multiple antibodies or complex serologic issues are present
Bill 86077 separately from the technical component crossmatch (86920 or 86921)
Impact: Captures both technical lab fee ($86920) and physician interpretation fee ($51.11 for 86077), potentially recovering $80+ per crossmatch when both billed appropriately
Ensure physician signature and dated interpretation in blood bank records before claim submission
Impact: Missing signature is the #1 denial reason; proper documentation prevents 100% payment denial
Use modifier 91 for medically necessary repeat crossmatch interpretations same day
Impact: Allows additional $51.11 payment for each repeat interpretation when resolving incompatibilities or with changing patient antibody status
Bill per unit crossmatched when physician reviews multiple units for same patient
Impact: Each unit requiring physician review is separately billable; 3 units = $153.33 (3 x $51.11) when properly documented
Verify facility vs non-facility status; hospital-based blood banks typically bill facility rate
Impact: Affects reimbursement by $4.85 per service ($51.11 non-facility vs $46.26 facility); confirm place of service coding

Common denials

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Frequently asked questions

What is CPT code 86077 used for?

CPT 86077 is used to bill for physician blood bank services involving crossmatch interpretation. It represents the professional component where a physician reviews blood compatibility testing, evaluates serologic results, and makes clinical decisions about transfusion suitability before blood products are released to patients.

How much does Medicare pay for CPT 86077 in 2025?

Medicare pays $51.11 for CPT 86077 in non-facility settings and $46.26 in facility settings for 2025. The code has a work RVU of 0.94 and total RVU of 1.58, based on the 2025 Medicare Physician Fee Schedule with conversion factor 32.3465.

What is the difference between 86077 and 86920/86921?

CPT 86077 is the physician professional service for interpreting crossmatch results and making compatibility decisions. CPT 86920 and 86921 are the technical laboratory procedures for performing the actual crossmatch testing. In many settings, both the technical code (86920/86921) and professional code (86077) can be billed when services are properly separated and documented.

Can CPT 86077 be billed for each unit of blood crossmatched?

Yes, CPT 86077 can be billed per unit when a physician provides separate interpretation and compatibility assessment for each donor unit. Documentation must show individual physician review of each unit's compatibility with specific donor unit numbers and separate clinical assessments to support multiple billings.

Who can bill CPT code 86077?

CPT 86077 must be billed by or under the supervision of a physician with expertise in transfusion medicine or blood banking, typically a pathologist board-certified in Clinical Pathology or with subspecialty certification in Blood Banking/Transfusion Medicine. The physician must personally review and interpret the crossmatch results and document their assessment.

What documentation is required to bill 86077?

Required documentation includes the physician's signed interpretation with date, patient and donor unit identification, crossmatch test results, compatibility assessment, any antibody or serologic issues identified, clinical indication for transfusion, and specific recommendation regarding transfusion suitability. Documentation must be in blood bank records and clearly show physician professional judgment beyond routine technical results.

Is CPT 86077 covered by Medicare?

Yes, CPT 86077 is covered by Medicare when medically necessary and properly documented. Coverage requires physician interpretation of crossmatch results with documented clinical decision-making regarding blood compatibility. Routine automated crossmatches without physician interpretation complexity may not meet medical necessity requirements for separate professional component billing.