CPT code 86078: Blood bank service, transfusion reaction investigation2026 Medicare rate & RVUs in Utah
A physician investigates a suspected transfusion reaction by evaluating the clinical event and relevant blood bank findings to help determine its cause.
In Utah, Medicare pays $50.12 for 86078 in the office and $39.14 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.
On this page 11 sections
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 Utah 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. Utah pays $50.12. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Utah · this page$50.12
- Los Angeles, CA · California$55.62+$5.50
- Washington, DC area · District of Columbia$56.67+$6.55
- Miami, FL · Florida$54.77+$4.65
- Chicago, IL · Illinois$53.91+$3.79
- Manhattan, NY · New York$57.47+$7.35
- Alaska · Alaska$67.29+$17.17
Other areas in Utah first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $48.33 | $38.10 |
| ArkansasArkansas | $47.94 | $37.90 |
| ArizonaArizona | $50.61 | $39.28 |
| Bakersfield, CACalifornia | $53.20 | $40.38 |
| Chico, CACalifornia | $53.01 | $40.20 |
| El Centro, CACalifornia | $53.02 | $40.21 |
| Fresno, CACalifornia | $53.01 | $40.20 |
| Hanford, CACalifornia | $53.01 | $40.20 |
| Madera, CACalifornia | $53.01 | $40.20 |
| Merced, CACalifornia | $53.01 | $40.20 |
| Modesto, CACalifornia | $53.01 | $40.20 |
| Napa, CACalifornia | $58.61 | $43.20 |
| Oxnard, CACalifornia | $55.13 | $41.32 |
| Redding, CACalifornia | $53.01 | $40.20 |
| Rest of CaliforniaCalifornia | $53.01 | $40.20 |
| Riverside, CACalifornia | $53.57 | $40.76 |
| Sacramento, CACalifornia | $54.87 | $41.28 |
| Salinas, CACalifornia | $54.64 | $41.09 |
| San Diego, CACalifornia | $55.33 | $41.34 |
| Marin County, CACalifornia | $61.26 | $44.78 |
| San Francisco, CACalifornia | $61.20 | $44.72 |
| San Benito County, CACalifornia | $62.46 | $45.60 |
| Santa Clara County, CACalifornia | $62.23 | $45.37 |
| San Luis Obispo, CACalifornia | $53.83 | $40.52 |
| Santa Cruz, CACalifornia | $55.40 | $41.20 |
| Santa Maria, CACalifornia | $54.68 | $41.05 |
| Santa Rosa, CACalifornia | $55.93 | $41.57 |
| Stockton, CACalifornia | $53.01 | $40.20 |
| Vallejo, CACalifornia | $58.52 | $43.12 |
| Visalia, CACalifornia | $53.01 | $40.20 |
| Yuba City, CACalifornia | $53.01 | $40.20 |
| ColoradoColorado | $52.66 | $40.22 |
| ConnecticutConnecticut | $53.87 | $41.28 |
| DelawareDelaware | $51.19 | $39.64 |
| Fort Lauderdale, FLFlorida | $53.03 | $41.19 |
| Rest of FloridaFlorida | $51.44 | $40.26 |
| Atlanta, GAGeorgia | $52.17 | $40.29 |
| Rest of GeorgiaGeorgia | $49.70 | $39.27 |
| Hawaii, Guam, HIHawaii | $53.34 | $40.05 |
| IowaIowa | $48.81 | $38.12 |
| IdahoIdaho | $49.03 | $38.28 |
| East St. Louis, ILIllinois | $51.61 | $40.85 |
| Rest of IllinoisIllinois | $50.72 | $40.05 |
| Suburban Chicago, ILIllinois | $53.46 | $41.45 |
| IndianaIndiana | $49.19 | $38.35 |
| KansasKansas | $48.78 | $38.21 |
| KentuckyKentucky | $49.18 | $38.79 |
| New Orleans, LALouisiana | $50.54 | $39.54 |
| Rest of LouisianaLouisiana | $49.18 | $38.83 |
| Metropolitan Boston, MAMassachusetts | $56.21 | $42.25 |
| Rest of MassachusettsMassachusetts | $52.60 | $40.29 |
| Baltimore area, MDMaryland | $53.71 | $41.17 |
| Rest of MarylandMaryland | $51.84 | $40.01 |
| Rest of MaineMaine | $49.28 | $38.53 |
| Southern Maine, MEMaine | $50.65 | $39.06 |
| Detroit, MIMichigan | $51.92 | $40.64 |
| Rest of MichiganMichigan | $50.00 | $39.32 |
| MinnesotaMinnesota | $50.81 | $38.78 |
| Metropolitan Kansas City, MOMissouri | $50.24 | $39.26 |
| Metropolitan St. Louis, MOMissouri | $50.53 | $39.40 |
| Rest of MissouriMissouri | $48.77 | $38.69 |
| MississippiMississippi | $48.36 | $38.29 |
| MontanaMontana | $51.43 | $39.74 |
| North CarolinaNorth Carolina | $49.56 | $38.65 |
| North DakotaNorth Dakota | $50.45 | $38.76 |
| NebraskaNebraska | $48.93 | $38.14 |
| New HampshireNew Hampshire | $52.01 | $39.84 |
| Northern New JerseyNew Jersey | $56.53 | $42.97 |
| Rest of New JerseyNew Jersey | $54.58 | $41.81 |
| New MexicoNew Mexico | $50.19 | $39.47 |
| NevadaNevada | $51.18 | $39.48 |
| NYC suburbs and Long Island, NYNew York | $58.43 | $44.53 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $54.98 | $42.18 |
| Queens, NYNew York | $57.61 | $43.79 |
| Rest of New YorkNew York | $49.99 | $38.88 |
| OhioOhio | $49.79 | $39.12 |
| OklahomaOklahoma | $49.03 | $38.59 |
| Portland, OROregon | $53.61 | $40.63 |
| Rest of OregonOregon | $50.87 | $39.22 |
| Metropolitan Philadelphia, PAPennsylvania | $53.09 | $40.92 |
| Rest of PennsylvaniaPennsylvania | $49.78 | $39.05 |
| Puerto RicoPuerto Rico | $51.62 | $39.80 |
| Rhode IslandRhode Island | $52.47 | $40.39 |
| South CarolinaSouth Carolina | $49.74 | $38.94 |
| South DakotaSouth Dakota | $50.33 | $38.64 |
| TennesseeTennessee | $48.93 | $38.31 |
| Austin, TXTexas | $52.41 | $40.04 |
| Beaumont, TXTexas | $49.61 | $38.97 |
| Brazoria, TXTexas | $51.14 | $39.56 |
| Dallas, TXTexas | $51.40 | $39.76 |
| Fort Worth, TXTexas | $51.23 | $39.71 |
| Galveston, TXTexas | $51.26 | $39.65 |
| Houston, TXTexas | $52.18 | $40.57 |
| Rest of TexasTexas | $50.30 | $39.21 |
| VirginiaVirginia | $50.62 | $39.13 |
| Virgin Islands, VIUnited States Virgin Islands | $51.62 | $39.80 |
| VermontVermont | $50.42 | $38.85 |
| Rest of WashingtonWashington | $52.45 | $40.14 |
| King County, WAWashington | $56.99 | $42.65 |
| WisconsinWisconsin | $49.48 | $38.28 |
| West VirginiaWest Virginia | $49.66 | $39.50 |
| WyomingWyoming | $51.00 | $39.31 |
86078 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$47.94
$67.29
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $67.29 | 1 |
| AL | $48.33 | 1 |
| AR | $47.94 | 1 |
| AZ | $50.61 | 1 |
| CA | $53.01–$62.46 | 29 |
| CO | $52.66 | 1 |
| CT | $53.87 | 1 |
| DC | $56.67 | 1 |
| DE | $51.19 | 1 |
| FL | $51.44–$54.77 | 3 |
| GA | $49.70–$52.17 | 2 |
| GU | $53.34 | 1 |
| HI | $53.34 | 1 |
| IA | $48.81 | 1 |
| ID | $49.03 | 1 |
| IL | $50.72–$53.91 | 4 |
| IN | $49.19 | 1 |
| KS | $48.78 | 1 |
| KY | $49.18 | 1 |
| LA | $49.18–$50.54 | 2 |
| MA | $52.60–$56.21 | 2 |
| MD | $51.84–$56.67 | 3 |
| ME | $49.28–$50.65 | 2 |
| MI | $50.00–$51.92 | 2 |
| MN | $50.81 | 1 |
| MO | $48.77–$50.53 | 3 |
| MS | $48.36 | 1 |
| MT | $51.43 | 1 |
| NC | $49.56 | 1 |
| ND | $50.45 | 1 |
| NE | $48.93 | 1 |
| NH | $52.01 | 1 |
| NJ | $54.58–$56.53 | 2 |
| NM | $50.19 | 1 |
| NV | $51.18 | 1 |
| NY | $49.99–$58.43 | 5 |
| OH | $49.79 | 1 |
| OK | $49.03 | 1 |
| OR | $50.87–$53.61 | 2 |
| PA | $49.78–$53.09 | 2 |
| PR | $51.62 | 1 |
| RI | $52.47 | 1 |
| SC | $49.74 | 1 |
| SD | $50.33 | 1 |
| TN | $48.93 | 1 |
| TX | $49.61–$52.41 | 8 |
| UT | $50.12 | 1 |
| VA | $50.62–$56.67 | 2 |
| VI | $51.62 | 1 |
| VT | $50.42 | 1 |
| WA | $52.45–$56.99 | 2 |
| WI | $49.48 | 1 |
| WV | $49.66 | 1 |
| WY | $51.00 | 1 |
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.
How the rate is built · 86078
RVUs × geographic indexes × conversion factor
Work0.92
0.92 RVUs× 1.000 GPCI
Practice expense0.57
0.57 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
1.5400
Conversion factor
$33.4009
Medicare rate
$51.44
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Utah inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
10,600
- Code
- 86078
- Physician work
- 0.92
- Practice expense
- 0.57
- Malpractice
- 0.05
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.92 | × 1.000 | 0.9200 |
| Practice expense | 0.57 | × 0.940 | 0.5358 |
| Malpractice | 0.05 | × 0.898 | 0.0449 |
| Total RVUs | 1.5007 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Utah$50.12
Office: (0.92 × 1 + 0.57 × 0.94 + 0.05 × 0.898) × $33.4009 = $50.12
Facility: (0.92 × 1 + 0.22 × 0.94 + 0.05 × 0.898) × $33.4009 = $39.14
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.
Place of service · 86078
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$51.44
- Non-facility (office)
- $51.44
- Facility
- $39.75
Higher because the practice carries its own overhead.
How 86078 has changed in Utah
86078 · Office / nonfacility
$50.12
Effective 2026-10-01
The base rate is $0.40 higher than on 2025-10-01, moving from $49.72 to $50.12 (0.8%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$49.72changed to$50.12
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.94 changed to 0.92
- Practice expense RVU 0.60 changed to 0.57
- Malpractice RVU 0.04 changed to 0.05
- Practice expense GPCI 0.933 changed to 0.940
- Malpractice GPCI 0.930 changed to 0.898
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$51.16changed to$49.72
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 0.59 changed to 0.60
- Malpractice RVU 0.05 changed to 0.04
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$50.33changed to$51.16
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$51.54changed to$50.33
- Conversion factor 33.8872 changed to 32.7442
- Malpractice RVU 0.04 changed to 0.05
- Practice expense GPCI 0.926 changed to 0.933
- Malpractice GPCI 0.865 changed to 0.930
January 1, 2023
RVU23A
$51.72changed to$51.54
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.56 changed to 0.59
- Malpractice RVU 0.05 changed to 0.04
- Practice expense GPCI 0.919 changed to 0.926
- Malpractice GPCI 0.799 changed to 0.865
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$52.47changed to$51.72
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 0.57 changed to 0.56
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$54.68changed to$52.47
- Conversion factor 36.0896 changed to 34.8931
- Practice expense GPCI 0.923 changed to 0.919
- Malpractice GPCI 0.982 changed to 0.799
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$55.35changed to$54.68
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 0.58 changed to 0.57
- Practice expense GPCI 0.927 changed to 0.923
- Malpractice GPCI 1.165 changed to 0.982
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$56.29changed to$55.35
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 0.61 changed to 0.58
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$56.08changed to$56.29
- Conversion factor 35.8887 changed to 35.9996
- Practice expense GPCI 0.925 changed to 0.927
- Malpractice GPCI 1.167 changed to 1.165
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$55.56changed to$56.08
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 0.60 changed to 0.61
- Practice expense GPCI 0.922 changed to 0.925
- Malpractice GPCI 1.169 changed to 1.167
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$55.09changed to$55.56
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 0.58 changed to 0.60
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$54.82changed to$55.09
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$53.49changed to$54.82
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 0.54 changed to 0.58
- Practice expense GPCI 0.919 changed to 0.922
- Malpractice GPCI 1.136 changed to 1.169
Held through RVU15B.
January 1, 2014
RVU14A
$52.24changed to$53.49
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 0.59 changed to 0.54
- Practice expense GPCI 0.916 changed to 0.919
- Malpractice GPCI 1.102 changed to 1.136
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $52.24
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $50.12 | $39.14 | RVU26D |
| 2026-07-01 | $50.12 | $39.14 | RVU26C |
| 2026-04-01 | $50.12 | $39.14 | RVU26B |
| 2026-01-01 | $50.12 | $39.14 | RVU26A |
| 2025-10-01 | $49.72 | $45.49 | RVU25D |
| 2025-07-01 | $49.72 | $45.49 | RVU25C |
| 2025-04-01 | $49.72 | $45.49 | RVU25B |
| 2025-01-01 | $49.72 | $45.49 | RVU25A |
| 2024-10-01 | $51.16 | $46.81 | RVU24D |
| 2024-07-01 | $51.16 | $46.81 | RVU24C |
| 2024-04-01 | $51.16 | $46.81 | RVU24B |
| 2024-03-09 | $51.16 | $46.81 | RVU24AR |
| 2024-01-01 | $50.33 | $46.05 | RVU24A |
| 2023-10-01 | $51.54 | $47.46 | RVU23D |
| 2023-07-01 | $51.54 | $47.46 | RVU23C |
| 2023-04-01 | $51.54 | $47.46 | RVU23B |
| 2023-01-01 | $51.54 | $47.46 | RVU23A |
| 2022-10-01 | $51.72 | $48.22 | RVU22D |
| 2022-07-01 | $51.72 | $48.22 | RVU22C |
| 2022-04-01 | $51.72 | $48.22 | RVU22B |
| 2022-01-01 | $51.72 | $48.22 | RVU22A |
| 2021-10-01 | $52.47 | $48.94 | RVU21D |
| 2021-07-01 | $52.47 | $48.94 | RVU21C |
| 2021-04-01 | $52.47 | $48.94 | RVU21B |
| 2021-01-01 | $52.47 | $48.94 | RVU21A |
| 2020-10-01 | $54.68 | $51.35 | RVU20D |
| 2020-07-01 | $54.68 | $51.35 | RVU20C |
| 2020-04-01 | $54.68 | $51.35 | RVU20B |
| 2020-01-01 | $54.68 | $51.35 | RVU20A |
| 2019-10-01 | $55.35 | $51.68 | RVU19D |
| 2019-07-01 | $55.35 | $51.68 | RVU19C |
| 2019-04-01 | $55.35 | $51.68 | RVU19B |
| 2019-01-01 | $55.35 | $51.68 | RVU19A |
| 2018-10-01 | $56.29 | $52.62 | RVU18D |
| 2018-07-01 | $56.29 | $52.62 | RVU18C |
| 2018-04-01 | $56.29 | $52.62 | RVU18B |
| 2018-01-01 | $56.29 | $52.62 | RVU18AR1 |
| 2017-10-01 | $56.08 | $52.10 | RVU17D |
| 2017-07-01 | $56.08 | $52.10 | RVU17C |
| 2017-04-01 | $56.08 | $52.10 | RVU17B |
| 2017-01-01 | $56.08 | $52.10 | RVU17A |
| 2016-10-01 | $55.56 | $51.92 | RVU16D |
| 2016-07-01 | $55.56 | $51.92 | RVU16C |
| 2016-04-01 | $55.56 | $51.92 | RVU16B |
| 2016-01-01 | $55.56 | $51.92 | RVU16A |
| 2015-10-01 | $55.09 | $51.45 | RVU15D |
| 2015-07-01 | $55.09 | $51.45 | RVU15C |
| 2015-04-01 | $54.82 | $51.19 | RVU15B |
| 2015-01-01 | $54.82 | $51.19 | RVU15A |
| 2014-10-01 | $53.49 | $50.19 | RVU14D |
| 2014-07-01 | $53.49 | $50.19 | RVU14C |
| 2014-04-01 | $53.49 | $50.19 | RVU14B |
| 2014-01-01 | $53.49 | $50.19 | RVU14A |
| 2013-10-01 | $52.24 | $48.50 | RVU13D |
| 2013-07-01 | $52.24 | $48.50 | RVU13C |
| 2013-04-01 | $52.24 | $48.50 | RVU13B |
| 2013-01-01 | $52.24 | $48.50 | RVU13AR |
Where the Utah rate applies
Utah is a Medicare payment area, not a city. Our Census mapping connects it to 334 cities and communities in Utah. Some span more than one payment area; confirm with the service ZIP.
- Alpine
- Alta
- Altamont
- Alton
- Amalga
- American Fork
- Aneth
- Annabella
86078 billing questions
How is 86078 different from 86077?
86078 is for a physician’s investigation of a suspected transfusion reaction. 86077 concerns physician review of compatibility testing, not investigation of a reaction.
When should 86079 be reported instead?
86079 concerns a physician’s authorization to release blood or a blood product outside standard release procedures. It is not the code for evaluating a suspected transfusion reaction.
Does 86078 cover the laboratory tests in the reaction workup?
The code represents the physician’s investigation, not a count of laboratory assays. Report distinct tests, such as antibody screening or ABO typing, according to the services performed and documented.
What documentation supports reporting 86078?
Document the suspected transfusion reaction, the clinical and blood bank information reviewed, the physician’s conclusions, and any consultation or recommendations.
Is 86078 reported per test or per unit of blood?
The service is the physician’s investigation of the reaction, not each test result or each blood unit involved. The record should support the physician service reported.
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
Show the CMS file lines behind this rate
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