CPT 85009 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 | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 11 - Office 81 - Independent Laboratory |
| Common Modifiers | None TC - Technical component 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85009 |
| Medicaid Fee Schedule | View Medicaid rates for 85009 |
National average reimbursement for CPT 85009 by major payers:
$4.30
$3.09
$5.24
$7.15
CPT 85009 vs. Other Hematology and Coagulation Procedures Codes
The CPT 85009 code is part of the Pathology and Laboratory Procedures services used for Hematology and Coagulation 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 85009 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 |
|---|---|---|
| 85008-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. |
| 85009-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. |
| 85013-CPT | Low | Red Cell Volume (Hematocrit), The Hematocrit Test Looks At The Proportion Of Red Blood Cells As Part Of The Total Blood Volume. It Is Often Used To Detect Blood Loss Or Test For Iron Deficiency As Well As Other Conditions. |
| 85014-CPT | Low | Red Cell Volume (Hematocrit), The Hematocrit Test Looks At The Proportion Of Red Blood Cells As Part Of The Total Blood Volume. It Is Often Used To Detect Blood Loss Or Test For Iron Deficiency As Well As Other Conditions. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85009. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85009 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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