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See a sample rate comparisonCPT 85210 Fee Schedule
Medicare rates as of January 2026
CPT 85210 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
Blood Clotting Test, This Test Evaluates For A Lack Of Factor Ii Or Prothrombin In The Blood. A Deficiency Is Associated With Hemophilia And Is One Of The More Common Clotting Problems.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $12.98 national lab fee schedule rate (2026) · View Medicare rates for 85210 |
| Medicaid Fee Schedule | $12.235 median of the 8 states in the free preview · View Medicaid rates for 85210 |
National average reimbursement for CPT 85210 by major payers:
$11.63
BCBS / Anthem
$8.53
UnitedHealthcare
$15.39
Aetna
$19.59
Cigna
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CPT 85210
5 of 25 sample ratesHigher to lower in this preview
Tyler Regional Hospital LLC
$60.00Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$12.98Published rateSurgical Specialty Center Of Baton Rouge, LLC, Surgical Specialty Center Of Baton Rouge
Surgical Specialty Center Of Baton Rouge, LLC
$12.97Published rateChristopher Raio
St Joseph Hospital
$7.79Published rateHospital Service District Of The Parish Of St. Bernard, State Of Louis, St. Bernard Parish Hospital
Hospital Service District Of The Parish Of St Bernard State Of Louis
$5.44Published rate
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See a sample payer proposalCPT 85210 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85210. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 85170-CPT | Low | Platelet Retraction Test, This Test Looks At The Amount Of Time It Takes For Platelets To Create A Blood Clot. The Test Is Used To Diagnose Clotting Problems. |
| 85175-CPT | Low | Blood Clot Absorption Test, This Test Measures The Amount Of Time A Clot Takes To Dissolve Fully Into The Blood. Results Indicate The Health Of This Function. |
| 85210-CPT | Low | Blood Clotting Test, This Test Evaluates For A Lack Of Factor Ii Or Prothrombin In The Blood. A Deficiency Is Associated With Hemophilia And Is One Of The More Common Clotting Problems. |
| 85220-CPT | Low | Blood Clotting Test, The Test For Factor V Deficiency Evaluates A Suspected Problem With Blood Clotting. This Test Usually Is Combined With Tests Of Clot-Forming Time. Factor V Is One Of 13 Proteins Needed For Clotting. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85210. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85210 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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