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See a sample rate comparisonCPT 85270 Fee Schedule
Medicare rates as of January 2026
CPT 85270 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
Blood Clotting Test, This Test For A Deficiency Of Factor Xi Blood Clotting Protein Helps Verify Combined Clotting Protein Deficiencies.
| 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 85270 |
| Medicaid Fee Schedule | $16.465 median of the 8 states in the free preview · View Medicaid rates for 85270 |
National average reimbursement for CPT 85270 by major payers:
$16.02
BCBS / Anthem
$12.43
UnitedHealthcare
$21.58
Aetna
$27.37
Cigna
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CPT 85270
5 of 25 sample ratesHigher to lower in this preview
Brim Healthcare Of Texas LLC
$60.00Published rateScurry County Hospital District, Cogdell Memorial Hospital
Scurry County Hospital District
$21.47Published rateSt Davids Healthcare Partnership Lp LLP, Round Rock Medical Center
$17.89Published ratePalo Pinto County Hospital District, Palo Pinto General Hospital
$15.01Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$10.01Published rate
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See a sample payer proposalCPT 85270 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85270. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 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). |
| 85300-CPT | Low | Blood Clotting Test, Antithrombin Is A Protein That Prevents And Regulates Blood Clotting. The Test Is Done If A Person Or Family Members Have A History Of Blood Clots. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85270. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85270 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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