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See a sample rate comparisonCPT 85305 Fee Schedule
Medicare rates as of January 2026
CPT 85305 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $11.61 national lab fee schedule rate (2026) · View Medicare rates for 85305 |
| Medicaid Fee Schedule | $11.465 median of the 8 states in the free preview · View Medicaid rates for 85305 |
National average reimbursement for CPT 85305 by major payers:
$10.43
BCBS / Anthem
$12.75
UnitedHealthcare
$14.92
Aetna
$17.57
Cigna
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CPT 85305
5 of 25 sample ratesHigher to lower in this preview
Da Pediatric Rehabilitation
$60.00Published rateChristopher Raio
St Francis Hospital
$15.90Published ratePrisma Health-Upstate, Prisma Health Hillcrest Hospital Vascular Lab
Prisma Health - Upstate
$10.44Published rateChristopher Raio
St Francis Hospital
$6.97Published rateE And A Medical On The Go Healthcare Of South Florida LLC, E And A Healthcare On The Go
E And A Medical On The Go Healthcare Of South Florida LLC
$4.05Published rate
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See a sample payer proposalCPT 85305 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85305. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 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. |
| 85301-CPT | Low | Blood Clotting Test, Antithrombin Is A Protein That Prevents And Regulates Blood Clotting. This Test Measures The Amount Of Antithrombin Iii To Pinpoint The Cause Of Excessive Clotting. |
| 85302-CPT | Low | Blood Test Protein C, Measures The Level Of Protein C A Blood Protein Important In The Regulation Of 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 85305. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85305 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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