CPT 86079Laboratory

Phys blood bank serv authrj

CPT 86079 covers physician authorization and review services for blood bank procedures, including evaluation of patient compatibility testing needs and authorization of specialized blood products or transfusion protocols.

Showing rates for

National Average

Base Medicare rate

$50.78

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)

0.59

MP RVU

0.04

Total RVU

1.57

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Document the specific clinical indication requiring physician authorization rather than routine blood bank procedures
Impact: Prevents denials for services considered routine technical components; can protect 100% of the $50.78 Medicare payment
Bill 86079 only when physician personally reviews patient history, laboratory data, and authorizes specific blood bank protocols beyond standard procedures
Impact: Ensures compliance and reduces audit risk; inappropriate billing can trigger recoupment of all payments
Link authorization to specific antibody identification results, transfusion history, or special blood product requirements in documentation
Impact: Strengthens medical necessity; increases clean claim rate by 30-40% compared to generic documentation
Do not bill 86079 for routine type and screen authorizations; reserve for complex immunohematologic decision-making
Impact: Prevents routine denials; Medicare reviews show 60-70% denial rate when billed for routine procedures
Ensure time-dated physician signature or electronic authentication on authorization forms with clinical rationale
Impact: Required for payment; missing signatures result in 100% denial and difficulty with retrospective appeals
Consider billing frequency limitations; multiple authorizations on same date require modifier 59 with distinct documentation
Impact: Without modifier 59, second authorization on same date typically denied; proper use recovers additional $50.78 per distinct service

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 86079?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is CPT code 86079 used for?

CPT 86079 is used to bill for physician blood bank authorization services when a doctor reviews patient information and laboratory results to authorize specialized blood transfusion procedures, particularly for complex cases involving antibodies or special blood product requirements.

How much does Medicare pay for CPT 86079 in 2025?

Medicare pays $50.78 for CPT 86079 in non-facility settings and $46.26 in facility settings under the 2025 Medicare Physician Fee Schedule, based on 1.57 total RVUs and a conversion factor of 32.3465.

Can 86079 be billed for routine type and screen orders?

No, CPT 86079 should not be billed for routine type and screen orders. This code is reserved for complex cases requiring physician authorization beyond standard protocols, such as patients with known antibodies, transfusion reaction history, or requiring special blood products.

What documentation is required to bill CPT 86079?

Required documentation includes physician signature and date, patient clinical history relevant to transfusion, laboratory results reviewed, specific blood products or procedures authorized with rationale, and explanation of why physician decision-making was necessary beyond routine blood bank protocols.

Who can bill CPT code 86079?

CPT 86079 can be billed by physicians board-certified or board-eligible in pathology, hematology, or transfusion medicine who personally review patient data and authorize blood bank services. This typically includes pathologists, transfusion medicine specialists, and hematologists working in hospital blood banks or transfusion services.

What is the difference between 86079 and other blood bank CPT codes?

CPT 86079 specifically covers physician authorization services (cognitive work), while other blood bank codes (86900-86999) cover technical laboratory procedures like antibody screening, crossmatching, and compatibility testing. The physician authorization is separate from the actual laboratory testing.

How many times can CPT 86079 be billed per patient?

CPT 86079 can be billed each time a physician provides distinct authorization services for different clinical indications or time points. Multiple authorizations on the same date require modifier 59 and separate documentation showing distinct clinical decision-making for each service.