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See a sample rate comparisonCPT 85240 Fee Schedule
Medicare rates as of January 2026
CPT 85240 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
Clotting; Factor Viii (Ahg), One Stage
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $17.90 national lab fee schedule rate (2026) · View Medicare rates for 85240 |
| Medicaid Fee Schedule | $17.675 median of the 8 states in the free preview · View Medicaid rates for 85240 |
National average reimbursement for CPT 85240 by major payers:
$15.55
BCBS / Anthem
$12.70
UnitedHealthcare
$21.39
Aetna
$26.62
Cigna
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CPT 85240
5 of 25 sample ratesHigher to lower in this preview
Citizens Medical Center County Of Victoria, County Of Victoria Citizens Medical Center
$48.74Published rateClhg-Ville Platte LLC, Mercy Regional Medical Center
$22.81Published rateCoastal Carolina Medical Center, Inc., Coastal Carolina Hospital
$17.89Published rateRolling Plains Memorial Hospital
The Nolan County Hospital District
$10.51Published rateEthicus Hospital Dfw LLC, Legent Orthopedic Hospital
Ethicus Hospital Dfw
$7.51Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 85240 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85240. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 85230-CPT | Low | Clot;Factor Vii-Proconvertin,Stable |
| 85240-CPT | Low | Clotting; Factor Viii (Ahg), One Stage |
| 85244-CPT | Low | Blood Clotting Test, The Test Measures The Quantity Of Blood Clotting Protein Factor Viii One Of 13 Proteins Required For Normal Blood Clotting. |
| 85245-CPT | Low | Blood Protein Binding Test, In This Test An Antibiotic Is Added To A Sample Of Blood Plasma To See If A Clot Begins To Form. The Test Can Identify Problems With Blood Clotting. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85240. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85240 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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