CPT 85097 Fee Schedule

CPT 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.

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.