CPT 85007 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Hematology and Coagulation Procedures Pathology and Laboratory Procedures |
| Common Place of Service | 21 - Inpatient Hospital 81 - Independent Laboratory |
| Common Modifiers | None 26 - Professional component TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85007 |
National average reimbursement for CPT 85007 by major payers:
$3.29
$2.57
$4.43
$5.95
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 85007 | $1.60 | 1851528566 - AMANDA AVERY | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Pediatric Nurse Practitioner (363LP0200X) |
United | 85007 | $1.60 | 1093976847 - CATHERINE DOCOUS | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Physician Assistant (363A00000X) |
United | 85007 | $1.99 | 1255503686 - KIMBERLY HURLEY | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 85007 | $3.16 | 1184616039 - RAPHAEL ALCURI | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Diagnostic Radiology Physician (2085R0202X) |
United | 85007 | $4.36 | 1952329781 - ASHRAF ALY | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 85007 | $1.60 | 1962464818 - JOHN ELLIS | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Diagnostic Radiology Physician (2085R0202X) |
United | 85007 | $3.16 | 1598885741 - MANZURUL SIKDER | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Hematology & Oncology Physician (207RH0003X) |
United | 85007 | $1.60 | 1306067517 - ROHIN MEHTA | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Anatomic Pathology Physician (207ZP0101X) |
United | 85007 | $3.16 | 1700873858 - BONNIE CASANOVA | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Family Nurse Practitioner (363LF0000X) |
United | 85007 | $3.16 | 1942854401 - LARA BELFIORE | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Family Nurse Practitioner (363LF0000X) |
United | 85007 | $1.60 | 1437291689 - MOHSIN SYED | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Internal Medicine Physician (207R00000X) |
United | 85007 | $1.60 | 1578874459 - ELAINE TSUKAYAMA | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Pediatrics Physician (208000000X) |
United | 85007 | $3.16 | 1124461066 - ROXANE HANDAL-OREFICE | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 85007 | $4.36 | 1679567887 - THANG LE | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Internal Medicine Physician (207R00000X) |
United | 85007 | $1.60 | 1740909704 - CAITLIN POWERS | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Physical Therapist (225100000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 85007 vs. Other Pathology and Laboratory Procedures Codes
The CPT 85007 code is part of the Hematology and Coagulation Procedures services used for Pathology and Laboratory Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 85007 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 85004-CPT | Low | Automated Count Of Blood Cells, Machine Blood Count Measuring The Number Of White Cells (Wbcs) Red Cells (Rbcs) And Platelets. |
| 85007-CPT | Low | Manual Blood Count, Routine Blood Test Where A Sample Is Examined Under A Microscope. The Basic Components Are Counted: White Blood Cells (Wbcs) Red Blood Cells And Platelets. The Five Wbc Types Also May Be Counted: Neutrophils Lymphocytes Monocytes Eosinophils Basophils. |
| 85018-CPT | Low | Hemoglobin Count, The Hemoglobin Count Helps To Evaluate The Amount Of Iron In The Blood. It Can Be Done As Part Of A Complete Blood Count (Cbc). A Low Count Can Be An Indicator Of Anemia. |
| 85025-CPT | Low | Complete Blood Count (Cbc), A Complete Blood Count Includes Red Blood Cells White Blood Cells Hemoglobin Hematocrit Platelets And Distribution Of The Cells Within The Blood Volume Sampled. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85007. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85007 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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