Billing code 86078: Blood bank serviceMedicare rate & RVUs
A physician investigates a suspected transfusion reaction by evaluating the clinical event and relevant blood bank findings to help determine its cause.
Medicare pays $51.44 for 86078 nationally in the office and $39.75 in a hospital or facility. Local office rates run $47.94–$67.29.
Medicare rate · 86078
Blood bank service
Swap in your local Medicare rate.
- Work RVUs
- 0.92
- Total RVUs
- 1.54
- Global days
- XXX
National rate · 2026
$51.44
Office setting, before claim adjustments.
See every locality for 86078 → · Billed by an NP, PA or therapist? →
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 10 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; the supplied CMS facts list no additional payment rules for it.
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 86078 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$47.94 to $67.29
109 of 109 payment localities
86078 rates by state
Office rate range in each state. Select a state to see its payment localities.
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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
Swap in your local Medicare rate.
Work 0.92Practice expense 0.57Malpractice 0.05
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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).
Non-facility (office) rate · national
$51.44
The facility rate would be $39.75 (+$11.69). In a facility, the facility bills its own costs separately.
86078 compared with similar codes
Compare codes
86078 vs 86077 vs 86079 vs 86850: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 86077Blood bank service
- Choose 86078 when the physician investigates a suspected transfusion reaction; 86077 describes physician review of compatibility testing.
- 86079Blood bank service
- Choose 86079 for physician authorization to release blood outside standard procedures. Use 86078 for a physician’s reaction investigation.
- 86850Rbc antibody screen
- 86850 reports an antibody screening test. It does not represent the physician’s assessment of a suspected transfusion reaction.
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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