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See a sample rate comparisonCPT 85130 Fee Schedule
Medicare rates as of January 2026
CPT 85130 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
Test With Colorizing Material, This Test Method Is Called A Chromogenic Substrate Assay. When Mixed With A Test Sample The Solution Changes Color. It Is Used For A Variety Of Blood Tests Especially Those That Check Clotting Factors.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 21 - Inpatient Hospital 81 - Independent Laboratory |
| Common Modifiers | 26 - Professional component 91 - Repeat Lab Test |
| Complexity Level | Low |
| Medicare Fee Schedule | $11.89 national lab fee schedule rate (2026) · View Medicare rates for 85130 |
| Medicaid Fee Schedule | $10.935 median of the 8 states in the free preview · View Medicaid rates for 85130 |
National average reimbursement for CPT 85130 by major payers:
$10.68
BCBS / Anthem
$15.04
UnitedHealthcare
$13.78
Aetna
$17.69
Cigna
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CPT 85130
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$26.16Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$11.89Published ratePrisma Health-Upstate, Prisma Health Op Surgery Spartanburg
Prisma Health - Upstate
$10.69Published rateChildrens National Medical Center
Childrens Hospital
$7.13Published rateE And A Medical On The Go Healthcare Of South Florida LLC, E And A Healthcare On The Go
E And A Medical On The Go Healthcare Of South Florida LLC
$4.15Published rate
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See a sample payer proposalCPT 85130 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85130. Select one to see its fee schedule.
| 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. |
| 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. |
| 85130-CPT | Low | Test With Colorizing Material, This Test Method Is Called A Chromogenic Substrate Assay. When Mixed With A Test Sample The Solution Changes Color. It Is Used For A Variety Of Blood Tests Especially Those That Check Clotting Factors. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85130 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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