CPT code 86078: Blood bank service, transfusion reaction investigation2026 Medicare rate & RVUs in Queens, NY

In Queens, NY, Medicare pays $57.61 for 86078 in the office and $43.79 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 86078 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 86078 covers

This service covers a physician’s investigation of a suspected reaction occurring during or after a blood transfusion. A transfusion medicine physician or pathologist typically reviews the patient’s clinical course and blood bank findings, such as compatibility testing and reaction-workup results, and may discuss the findings with the treating team. The investigation supports decisions about the reaction’s cause and the patient’s transfusion care in a hospital or blood bank setting.

Report 86078 for the physician’s reaction investigation, rather than for an individual laboratory assay or simply because a transfusion reaction workup was ordered. Documentation should identify the suspected reaction, the records and test results reviewed, the physician’s assessment, and any consultation or recommendations. Distinct laboratory tests performed during the workup are reported according to the services actually performed. CMS physician fee schedule values for this code reflect physician work and practice expense.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Queens, NY compares for 86078

Across 109 of 109 payment localities, the office rate for 86078 runs from $47.94 in Arkansas to $67.29 in Alaska. Queens, NY pays $57.61. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

86078 rates by state

Office rate range in each state. Select a state to see its payment localities.

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How the 86078 rate is calculated

Each of 86078’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 86078

86078 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Codes related to 86078

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 86078 has changed in Queens, NY

Price 86078 for an earlier date of service

Where the Queens, NY rate applies

Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

• 86078 in New York · multiple payment areas

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Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates