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See a sample rate comparisonCPT 85291 Fee Schedule
Medicare rates as of January 2026
CPT 85291 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 22 - On Campus Outpatient Hospital |
| Common Modifiers | 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $9.11 national lab fee schedule rate (2026) · View Medicare rates for 85291 |
| Medicaid Fee Schedule | $8.995 median of the 8 states in the free preview · View Medicaid rates for 85291 |
National average reimbursement for CPT 85291 by major payers:
$8.25
BCBS / Anthem
$6.44
UnitedHealthcare
$11.23
Aetna
$13.51
Cigna
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CPT 85291
5 of 25 sample ratesHigher to lower in this preview
Restorative Health Rehabilitation Inc
$35.00Published rateChristopher Raio
St Francis Hospital
$10.08Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$9.11Published rateOur Lady Of Lourdes Regional Medical Center,Inc
Our Lady Of Lourdes Regional Medical Center Inc
$9.10Published rateGraham Regional Medical Center, Graham General Hsopital Physicians
$4.61Published rate
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See a sample payer proposalCPT 85291 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85291. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 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. |
| 85305-CPT | Low | Blood Clotting Protein Test, Protein S Plays A Role In Regulating The Blood Clotting Process. 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 85291. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85291 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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