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See a sample rate comparisonCPT 85055 Fee Schedule
Last Verified: October 2026
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.
Platelet Health Evaluation, This Evaluation Examines Newly Produced Platelets. The Amount Indicates The Health Of Platelet Production. This Is Particularly Useful In Evaluating Health After A Bone Marrow Transplant Chemotherapy Or Hiv Treatment.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 21 - Inpatient Hospital 11 - Office |
| Common Modifiers | 26 - Professional component PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
| Medicare Fee Schedule | $35.74 national lab fee schedule rate (2026) · View Medicare rates for 85055 |
| Medicaid Fee Schedule | $32.885 median of the 8 states in the free preview · View Medicaid rates for 85055 |
National average reimbursement for CPT 85055 by major payers:
$28.63
$20.84
$34.09
$50.07
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CPT 85055
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$78.63Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$47.18Published rateChristopher Raio
St Joseph Hospital
$36.69Published ratePrisma Health-Upstate, Prisma Health Op Surgery Spartanburg
Prisma Health - Upstate
$32.16Published rateChristus Health Ark-La-Tex, Christus St. Michael Health System
Christus Health Ark-La-Tex
$15.01Published rate
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See a sample payer proposalCPT 85055 vs. Other Hematology and Coagulation Procedures Codes
The CPT 85055 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 85055 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. |
| 85055-CPT | Low | Platelet Health Evaluation, This Evaluation Examines Newly Produced Platelets. The Amount Indicates The Health Of Platelet Production. This Is Particularly Useful In Evaluating Health After A Bone Marrow Transplant Chemotherapy Or Hiv Treatment. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85055. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85055 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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