Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 85220 Fee Schedule
Medicare rates as of January 2026
CPT 85220 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
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.
| 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 | $17.65 national lab fee schedule rate (2026) · View Medicare rates for 85220 |
| Medicaid Fee Schedule | $16.24 median of the 8 states in the free preview · View Medicaid rates for 85220 |
National average reimbursement for CPT 85220 by major payers:
$15.66
BCBS / Anthem
$12.22
UnitedHealthcare
$21.48
Aetna
$26.75
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 85220.
CPT 85220
5 of 25 sample ratesHigher to lower in this preview
Da Pediatric Rehabilitation
$40.00Published rateChristopher Raio
St Francis Hospital
$20.97Published rateTenet Hospitals Limited, The Hospitals Of Providence East Campus
$17.64Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$10.59Published rateChristopher Raio
St Joseph Hospital
$9.53Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 85220 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85220. 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 85220. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85220 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 85220) and we'll show you how you compare in 15 minutes or less.