CPT 85290 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| 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 | None 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85290 |
| Medicaid Fee Schedule | View Medicaid rates for 85290 |
National average reimbursement for CPT 85290 by major payers:
$14.83
$11.12
$19.77
$24.88
CPT 85290 vs. Other Hematology and Coagulation Procedures Codes
The CPT 85290 code is part of the Pathology and Laboratory Procedures services used for Hematology and Coagulation Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 85290 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| 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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