CPT 85018 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 | 11 - Office 81 - Independent Laboratory |
| Common Modifiers | None QW - CLIA Waived Tests 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85018 |
National average reimbursement for CPT 85018 by major payers:
$2.29
$2.25
$3.14
$3.51
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 85018 | $2.36 | 1740273994 - ECTOR COUNTY HOSPITAL DISTRICT, MEDICAL CENTER HOSPITAL | 752302928 | TX | General Acute Care Hospital (282N00000X) |
United | 85018 | $5.84 | 1245809714 - BROOKE HENSCHEL | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Nurse Practitioner (363L00000X) |
United | 85018 | $2.36 | 1376591941 - HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH, LANE REGIONAL MEDICAL CENTER | 726015227 | LA | General Acute Care Hospital (282N00000X) |
United | 85018 | $1.75 | 1740453000 - GRAHAM REGIONAL MEDICAL CENTER, GRAHAM GENERAL HSOPITAL PHYSICIANS | 463113489 | TX | General Acute Care Hospital (282N00000X) |
United | 85018 | $2.83 | 1316931835 - WILBARGER COUNTY HOSPITAL DISTRICT, WILBARGER GENERAL HOSPITAL | 756047638 - (TX) WILBARGER GENERAL HOSPITAL EMPLOYEE BENEFIT PLAN | TX | General Acute Care Hospital (282N00000X) |
United | 85018 | $1.94 | 1497275853 - ALEXANDER TRAN MD PA | 821967465 - (TX) ALEXANDER TRAN MD PA | TX | General Acute Care Hospital (282N00000X) |
United | 85018 | $2.36 | 1457994188 - VHS HARLINGEN HOSPITAL COMPANY, LLC, VALLEY BAPTIST MICRO-HOSPITAL WESLACO | 452662980 | TX | General Acute Care Hospital (282N00000X) |
United | 85018 | $2.36 | 1912937624 - HILTON HEAD HEALTH SYSTEM, L.P., HILTON HEAD HOSPITAL | 934604680 | SC | General Acute Care Hospital (282N00000X) |
United | 85018 | $2.36 | 1609135904 - ANDREW CORONA | 922417967 | TX | General Acute Care Hospital (282N00000X) |
United | 85018 | $7.50 | 1841843455 - HCN EP HORIZON CITY, LLC, THE HOSPITALS OF PROVIDENCE EMERGENCY ROOM MONTWOOD | 813935393 - (TX) HCN EP HORIZON CITY LLC | TX | General Acute Care Hospital (282N00000X) |
United | 85018 | $2.36 | 1427472463 - RESOLUTE HOSPITAL COMPANY, LLC, RESOLUTE HEALTH HOSPITAL | 462942963 - (TX) RESOLUTE HOSPITAL COMPANY LLC | TX | General Acute Care Hospital (282N00000X) |
United | 85018 | $2.91 | 1104819366 - CHILDREN'S HOSPITAL | 720467503 - CHILDRENS HOSPITAL INC | LA | Children's Hospital (282NC2000X) |
United | 85018 | $1.94 | 1467442418 - NORTHWEST TEXAS HEALTHCARE SYSTEM INC, NORTHWEST TEXAS HEALTHCARE SYSTEM | 232238976 | TX | General Acute Care Hospital (282N00000X) |
United | 85018 | $1.99 | 1194983510 - LYNN COUNTY HOSPITAL DISTRICT | 751328354 - (TX) LYNN COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 85018 | $4.40 | 1942208616 - ST. LUKE'S COMMUNITY HEALTH SERVICES, ST. LUKE'S THE WOODLANDS HOSPITAL | 760536234 - (TX) ST LUKES COMMUNITY HEALTH SERVICES | TX | General Acute Care Hospital (282N00000X) |
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 85018 vs. Other Pathology and Laboratory Procedures Codes
The CPT 85018 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 85018 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 |
|---|---|---|
| 84586-CPT | Low | Pancreas Islet Cell Tumor Test, The Test Identifies Secretions Of Vasoactive Intestinal Peptide (Vip) Which Can Cause Watery Diarrhea Low Potassium And Low Levels Of Stomach Acid. Vip Is Secreted By Tumors Of The Pancreas Islet Cells. |
| 85002-CPT | Low | Blood Clotting Test, Bleeding Time (Blood Clotting Test) Checks How Quickly The Blood Clots When A Small Skin Cut Is Made. The Test Is An Indicator Of Platelet Function (Platelets Are Blood Cells Required For Blood Clotting). |
| 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. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85018. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85018 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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