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See a sample rate comparisonCPT 85290 Fee Schedule
Medicare rates as of January 2026
CPT 85290 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
Blood Clot Stabilization Test, The Blood Clot Stabilization Test Verifies A Deficiency Of Clotting Factor Xiii. A Shortage Of This Factor Causes Wounds To Reopen.
| 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 | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $16.34 national lab fee schedule rate (2026) · View Medicare rates for 85290 |
| Medicaid Fee Schedule | $15.03 median of the 8 states in the free preview · View Medicaid rates for 85290 |
National average reimbursement for CPT 85290 by major payers:
$14.83
BCBS / Anthem
$11.12
UnitedHealthcare
$19.77
Aetna
$24.88
Cigna
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CPT 85290
5 of 25 sample ratesHigher to lower in this preview
Emerus Bhs Sa Thousand Oaks LLC, Baptist Neighborhood Hospital Shavano Park
Emerus Bhs Sa Thousand Oaks LLC
$60.00Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$16.34Published rateEssent Prmc Lp, Paris Regional Medical Center
$16.34Published rateChildrens National Medical Center
Childrens Hospital
$9.80Published rateBrandon Okeefe Rafaeli
U T Physicians
$6.86Published rate
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See a sample payer proposalCPT 85290 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85290. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 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). |
| 85290-CPT | Low | Blood Clot Stabilization Test, The Blood Clot Stabilization Test Verifies A Deficiency Of Clotting Factor Xiii. A Shortage Of This Factor Causes Wounds To Reopen. |
| 85291-CPT | Low | Blood Clot Stabilization Test, The Blood Clot Stabilization Test Verifies A Deficiency Of Clotting Factor Xiii. A Shortage Of This Factor Causes Wounds To Reopen. |
| 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 85290. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85290 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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