CPT 85025 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 | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None 26 - Professional component QW - CLIA Waived Tests |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85025 |
| Medicaid Fee Schedule | View Medicaid rates for 85025 |
National average reimbursement for CPT 85025 by major payers:
$7.25
$5.58
$9.94
$11.39
CPT 85025 vs. Other Hematology and Coagulation Procedures Codes
The CPT 85025 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 85025 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 |
|---|---|---|
| 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). |
| 85004-CPT | Low | Automated Count Of Blood Cells, Machine Blood Count Measuring The Number Of White Cells (Wbcs) Red Cells (Rbcs) And Platelets. |
| 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 85025. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85025 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 85025) and we'll show you how you compare in 15 minutes or less.