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See a sample rate comparisonCPT 85260 Fee Schedule
Medicare rates as of January 2026
CPT 85260 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
Clotting; Factor X (Stuart-Prower)
| 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 85260 |
| Medicaid Fee Schedule | $16.465 median of the 8 states in the free preview · View Medicaid rates for 85260 |
National average reimbursement for CPT 85260 by major payers:
$16.04
BCBS / Anthem
$12.41
UnitedHealthcare
$21.70
Aetna
$27.28
Cigna
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CPT 85260
5 of 25 sample ratesHigher to lower in this preview
Hcn Ep Horizon City, LLC, The Hospitals Of Providence Horizon City Campus
Hcn Ep Horizon City LLC
$60.00Published rateChristopher Raio
St Francis Hospital
$24.54Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$17.90Published rateChristopher Raio
St Joseph Hospital
$10.74Published rateBsa Hospital LLC
$7.51Published rate
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See a sample payer proposalCPT 85260 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85260. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 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. |
| 85280-CPT | Low | Blood Clotting Test, Test For Factor Xii Clotting Protein Deficiency Helps To Confirm A Suspected Result From An Activated Partial Thromboplastin Test (Aptt). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85260. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85260 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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