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See a sample rate comparisonCPT 85097 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.
Bone Marrow Test Report, A Physician Reviews The Results Of Examining A Bone Marrow Sample (Biopsy) And Writes A Report.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | GC - Service performed by resident under supervision Q1 - Routine clinical service provided in a clinical research study |
| Complexity Level | Low |
| Medicare Fee Schedule | $67.80 national non-facility rate (2026) · View Medicare rates for 85097 |
| Medicaid Fee Schedule | $56.05 median of the 8 states in the free preview · View Medicaid rates for 85097 |
National average reimbursement for CPT 85097 by major payers:
$71.20
$49.33
$123.38
$53.67
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CPT 85097
5 of 25 sample ratesHigher to lower in this preview
Ashley O'Connor
Atlantic Health System Inc
$56.34Published rateMarie Lee
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$42.13Published rateRobert Hammond
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$35.81Published rateDerk Seabold
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$35.81Published rateH Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$35.81Published rate
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See a sample payer proposalCPT 85097 vs. Other Hematology and Coagulation Procedures Codes
The CPT 85097 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 85097 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. |
| 85097-CPT | Low | Bone Marrow Test Report, A Physician Reviews The Results Of Examining A Bone Marrow Sample (Biopsy) And Writes A Report. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85097. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85097 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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