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See a sample rate comparisonCPT 85230 Fee Schedule
Medicare rates as of January 2026
CPT 85230 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
Clot;Factor Vii-Proconvertin,Stable
| 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 | $17.90 national lab fee schedule rate (2026) · View Medicare rates for 85230 |
| Medicaid Fee Schedule | $16.465 median of the 8 states in the free preview · View Medicaid rates for 85230 |
National average reimbursement for CPT 85230 by major payers:
$16.03
BCBS / Anthem
$12.44
UnitedHealthcare
$21.52
Aetna
$27.22
Cigna
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CPT 85230
5 of 25 sample ratesHigher to lower in this preview
Woodlands Specialty Hospital
$60.00Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$21.27Published rateOur Lady Of Lourdes Regional Medical Center,Inc
Our Lady Of Lourdes Regional Medical Center Inc
$17.89Published rateLamb Healthcare Center
$10.51Published rateBsa Hospital LLC
$7.51Published rate
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See a sample payer proposalCPT 85230 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85230. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 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. |
| 85230-CPT | Low | Clot;Factor Vii-Proconvertin,Stable |
| 85240-CPT | Low | Clotting; Factor Viii (Ahg), One Stage |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85230. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85230 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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