CPT 85045 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 TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85045 |
National average reimbursement for CPT 85045 by major payers:
$3.54
$3.68
$5.08
$6.11
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 85045 | $5.47 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 85045 | $3.12 | 1164776688 - NICOLE SCHWAB | 362925195 - ALLERGY & ASTHMA OF DUPAGE, S.C. | IL | Family Nurse Practitioner (363LF0000X) |
United | 85045 | $3.99 | 1740273994 - ECTOR COUNTY HOSPITAL DISTRICT, MEDICAL CENTER HOSPITAL | 752302928 | TX | General Acute Care Hospital (282N00000X) |
United | 85045 | $3.99 | 1215969787 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE SIERRA CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 85045 | $3.99 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 85045 | $8.78 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 85045 | $2.27 | 1891774519 - LEON HOME HEALTH, LLC, LEON AT HOME | 261288029 | FL | Home Health Agency (251E00000X) |
United | 85045 | $3.50 | 1972071991 - GAINESVILLE COMMUNITY HOSPITAL, INC., NORTH TEXAS MEDICAL CENTER | 831683025 - (TX) GAINESVILLE COMMUNITY HOSPITAL INC | TX | General Acute Care Hospital (282N00000X) |
United | 85045 | $1.39 | 1598375651 - E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC, E AND A HEALTHCARE ON THE GO | 832289173 - (FL) E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC | FL | Home Health Agency (251E00000X) |
United | 85045 | $3.35 | 1073638490 - SHARRON ACOSTA M.D.P.A. | 742979530 - SHARRON ACOSTA, M.D., P.A. | TX | Ophthalmology Physician (207W00000X) |
United | 85045 | $2.35 | 1730106824 - NEVADA EYE CARE PROFESSIONALS LITTLE & STEIN, LTD. | 880316581 - NEVADA EYE CARE PROFESSIONALS | NV | Ophthalmology Physician (207W00000X) |
United | 85045 | $5.47 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 85045 | $2.34 | 1508859612 - GONZALES HEALTHCARE SYSTEMS, MEMORIAL HOSPITAL | 741625013 | TX | General Acute Care Hospital (282N00000X) |
United | 85045 | $5.27 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 85045 | $2.15 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
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 85045 vs. Other Hematology and Coagulation Procedures Codes
The CPT 85045 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 85045 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 |
|---|---|---|
| 85045-CPT | Low | Red Blood Cell Count, Reticulocytes Are Young Red Blood Cells (Rbcs). The Count Can Be Automated Or Manual Using A Microscope. It Is Used To Evaluate Both Anemia And How Well Bone Marrow Is Creating Rbcs. |
| 85046-CPT | Low | Reticyte Hgb Concentrate, Blood Count Reticulocytes Automated Including 1 Or More Cellular Parameters Eg Reticulocyte Hemoglobin Content Chr Immature Reticulocyte Fraction Irf Reticulocyte Volume Mrv Rna Content Direct Measurement |
| 85048-CPT | Low | White Blood Cell Count, Leukocytes Or White Blood Cells (Wbcs) Function As Part Of The Immune System. An Automated (Machine) Count Of The Wbcs Helps To Evaluate Whether An Infection Is Present The Response To A Treatment Or Whether Disease May Be Present. |
| 85049-CPT | Low | Platelet Count, Platelets Are The Cells That Help Clot The Blood After An Injury. An Automated (Machine) Platelet Count Determines The Number Of Platelets Present In A Sample Of Blood. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85045. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85045 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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