CPT code 86904: Serum antigen screen, per donor unit screened2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This blood-bank test uses patient serum to screen each donor blood unit for antigen compatibility when selecting a compatible unit for transfusion.
Medicare pays $16.34 for 86904 under the 2026 Clinical Laboratory Fee Schedule: one national amount, the same in every state and setting.
Medicare lab fee · CLFS 2026 Q4
National CLFS amount
$16.34
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2020
- Unchanged
- CMS updates
- Quarterly
Medicare pays the lesser of the lab’s charge and this amount. Patients usually owe no Part B deductible or coinsurance for covered clinical lab tests.
On this page 8 sections
What 86904 covers
A transfusion service or blood bank uses patient serum to screen candidate donor blood units for antigen compatibility when identifying a compatible unit. The test is performed on each unit considered; it is not one screen covering several units. It is part of blood-bank testing associated with selecting blood for transfusion.
Report one unit for each blood unit screened. Medicare pays 86904 only through the CLFS, at one nationally set amount with no locality or office-versus-facility variation. The 2026 national CLFS amount is $16.34, unchanged from 2020 through 2026. The code is excluded from the physician fee schedule.
This summary was written with AI assistance from CMS Clinical Laboratory Fee Schedule data. Amounts on this page come directly from CMS files.
How Medicare pays 86904
Clinical lab tests aren’t priced like physician services. They’re paid from their own fee schedule, with its own rules. See the whole lab fee schedule.
One national amount
CMS sets a single Clinical Laboratory Fee Schedule amount for 86904. There’s no geographic (GPCI) adjustment, so it pays the same in every state and payment locality.
No office or facility rate
Lab tests aren’t built from relative value units, so there’s no office and facility split: the place of service doesn’t change the CLFS amount.
Updated every quarter
CMS republishes the CLFS each quarter. New tests, often proprietary laboratory analyses (PLA codes), join during the year; existing amounts are updated each January.
Excluded from the physician fee schedule
The physician fee schedule lists 86904 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86904 on the lab fee schedule since 2020
86904 · CLFS 2026 Q4 (current)
$16.34
Unchanged since Jan 1, 2020
27 quarterly CLFS releases on file, first CLFS 2020 Q1. A code missing from a quarter wasn’t on that release.
86904 compared with similar tests
- 86902Donor antigen testEach antigen tested$6.35
- 86904 screens a donor unit using patient serum. 86902 describes typing donor blood for an antigen.
- 86920Compatibility testImmediate spin, per unitNo national amount
- 86920 is spin-method compatibility testing. 86904 is the patient-serum antigen screen used to assess a candidate donor unit.
- 86921Compatibility testIncubation techniqueNo national amount
- 86921 is incubated compatibility testing. 86904 reports patient-serum screening of a donor unit for antigen compatibility.
- 86922Antiglobulin crossmatchPer donor unitNo national amount
- 86922 is antiglobulin compatibility testing. 86904 describes the distinct patient-serum antigen-screening service.
86904 billing questions
When should the blood bank report 86904?
Report it when patient serum is used to screen a specific donor blood unit for antigen compatibility while selecting a compatible unit for transfusion.
How many units should be reported?
Report one unit for each donor blood unit screened. Do not use one unit to represent screening multiple donor units.
How is 86904 different from 86902?
86904 screens a donor unit using patient serum. 86902 describes typing donor blood for an antigen.
How is 86904 different from a crossmatch code?
86904 is an antigen screen using patient serum. Codes 86920–86923 describe compatibility testing using specified crossmatch approaches.
How does Medicare pay for 86904?
Medicare pays the test through the CLFS at one national amount, the same in every locality and without an office-versus-facility difference. It is excluded from the physician fee schedule.
Where this amount comes from
FeeBase reads lab amounts directly from the CMS Clinical Laboratory Fee Schedule file for the quarter: one row per code, with its payment indicator and national amount. Contractor-priced tests are labeled, never given a made-up amount. Amounts are Medicare payment limits, not a patient’s bill or a commercial rate.
CMS CLFS 2026 Q4 · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file line behind this amount
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