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See a sample rate comparisonCPT 85250 Fee Schedule
Medicare rates as of January 2026
CPT 85250 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
Blood Clotting Test, The Blood Clotting Factor Ix Test Is Part Of The Testing For Hemophilia B. When There Is A Deficiency Of Factor Ix Protein A Clot Takes Much Longer To Form.
| 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 | $19.04 national lab fee schedule rate (2026) · View Medicare rates for 85250 |
| Medicaid Fee Schedule | $17.515 median of the 8 states in the free preview · View Medicaid rates for 85250 |
National average reimbursement for CPT 85250 by major payers:
$17.00
BCBS / Anthem
$13.19
UnitedHealthcare
$22.92
Aetna
$28.72
Cigna
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CPT 85250
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$41.89Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$22.62Published rateSt Francis Medical Center, Inc
St Francis Medical Center Inc
$19.04Published rateAndrew Corona
Mid Coast Medical Center-Central
$15.96Published rateAaron Askew
The Orthopedic And Neurosurgical Center Of The Cascades
$8.00Published rate
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See a sample payer proposalCPT 85250 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85250. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 85247-CPT | Low | Blood Clotting Protein Test, In This Test A Sample Of Blood Plasma Is Examined For The Presence And Amount Of Von Willebrand Factor (Vwf) A Protein Essential For Delivering Protein Factor Viii To Wound Sites. Low Levels Of Vwf Weaken Blood Clotting Ability. |
| 85250-CPT | Low | Blood Clotting Test, The Blood Clotting Factor Ix Test Is Part Of The Testing For Hemophilia B. When There Is A Deficiency Of Factor Ix Protein A Clot Takes Much Longer To Form. |
| 85260-CPT | Low | Clotting; Factor X (Stuart-Prower) |
| 85270-CPT | Low | Blood Clotting Test, This Test For A Deficiency Of Factor Xi Blood Clotting Protein Helps Verify Combined Clotting Protein Deficiencies. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85250. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85250 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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