CPT code 86079: Blood bank service, transfusion authorization2026 Medicare rate & RVUs in Missouri
Reports a physician’s blood bank service when the physician reviews the circumstances and authorizes transfusion of a blood product or component.
Medicare pays $48.48–$50.21 for 86079 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 86079 covers
A transfusion medicine physician or blood bank pathologist uses this service to make and document a clinical decision authorizing release of blood or a blood component. It is associated with hospital transfusion-service work when the decision requires physician authorization, such as an urgent transfusion before compatibility testing is complete or a release decision involving an incompatible result. The code represents the physician’s authorization work, not the laboratory testing itself.
Report 86079 for the authorization decision rather than for compatibility testing, blood typing, or antibody screening. Documentation should identify the product under consideration, relevant test findings, the clinical reason for authorization, and the physician’s decision. CMS assigns physician work and practice expense to this service in the Physician Fee Schedule; the service should be supported by the physician’s documented blood bank work.
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.
Where 86079 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$48.48 to $50.21
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $49.92 | $38.95 |
| Metropolitan St. Louis, MO | $50.21 | $39.08 |
| Rest of Missouri | $48.48 | $38.40 |
How the 86079 rate is calculated
Each of 86079’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 · 86079
RVUs × geographic indexes × conversion factor
Work0.92
0.92 RVUs× 1.000 GPCI
Practice expense0.56
0.56 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
1.5300
Conversion factor
$33.4009
Medicare rate
$51.10
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 86079
86079 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 · 86079
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$51.10
- Non-facility (office)
- $51.10
- Facility
- $39.41
Higher because the practice carries its own overhead.
86079 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 86077Blood bank serviceComplex crossmatch interpretation
- 86077 represents physician evaluation of compatibility testing and unusual antibodies; 86079 represents authorization to transfuse blood or a component.
- 86078Blood bank serviceTransfusion reaction investigation
- 86078 is for physician investigation of a transfusion reaction. Choose 86079 when the physician’s service is authorization for transfusion, not reaction investigation.
- 86920Compatibility testImmediate spin, per unit
- 86920 reports laboratory crossmatch testing. Code 86079 reports the physician’s authorization decision, not the crossmatch procedure.
86079 billing questions
When should 86079 be chosen over 86077?
Use 86079 for physician authorization of a blood or blood-component transfusion. Code 86077 represents a different physician blood bank service involving compatibility testing and unusual antibody review.
Does 86079 report the crossmatch or antibody screen?
No. It reports the physician’s authorization decision, not the laboratory crossmatch or antibody-screen testing; those services have their own codes when performed and reportable.
What documentation supports 86079?
Record the blood product being considered, pertinent compatibility findings, why physician authorization was needed, and the physician’s decision to authorize transfusion.
Is 86079 the code for investigating a transfusion reaction?
No. Investigation of a transfusion reaction is represented by 86078; 86079 concerns authorization for transfusion of blood or a blood component.
Who typically performs the service?
A physician working with the hospital blood bank, commonly a transfusion medicine physician or blood bank pathologist, makes and documents the authorization decision.
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
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