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See a sample rate comparisonCPT 85378 Fee Schedule
Medicare rates as of January 2026
CPT 85378 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
Blood Clotting Problem Test, This Test Is Done To Detect A Problem In The System That Regulates Blood Clotting. It Can Also Detect Whether A Hidden Blood Clot (One That Did Not Produce Symptoms) Has Occurred.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 23 - Emergency Room 21 - Inpatient Hospital |
| Common Modifiers | 26 - Professional component TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | $9.72 national lab fee schedule rate (2026) · View Medicare rates for 85378 |
| Medicaid Fee Schedule | $9.60 median of the 8 states in the free preview · View Medicaid rates for 85378 |
National average reimbursement for CPT 85378 by major payers:
$7.99
BCBS / Anthem
$6.73
UnitedHealthcare
$9.84
Aetna
$14.50
Cigna
Compare published rates across providers.
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CPT 85378
5 of 25 sample ratesHigher to lower in this preview
Restorative Health Rehabilitation Inc
$55.00Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$9.78Published ratePrisma Health-Upstate, Prisma Health Int Med/Subspec Clinic
Prisma Health - Upstate
$8.75Published rateChristopher Raio
Mercy Medical Center
$5.83Published 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
$3.40Published rate
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See a sample payer proposalCPT 85378 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85378. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 85370-CPT | Low | Blood Clotting Problem Test, This Test Is Done To Detect A Problem In The System That Regulates Blood Clotting. It Can Also Detect Whether A Hidden Blood Clot (One That Did Not Produce Symptoms) Has Occurred. |
| 85378-CPT | Low | Blood Clotting Problem Test, This Test Is Done To Detect A Problem In The System That Regulates Blood Clotting. It Can Also Detect Whether A Hidden Blood Clot (One That Did Not Produce Symptoms) Has Occurred. |
| 85379-CPT | Low | Blood Clotting Problem Test, This Test Is Done To Detect A Problem In The System That Regulates Blood Clotting. It Can Also Detect Whether A Hidden Blood Clot (One That Did Not Produce Symptoms) Has Occurred. |
| 85380-CPT | Low | Blood Clotting Problem Test, This Test Is Done To Detect A Problem In The System That Regulates Blood Clotting. It Can Also Detect Whether A Hidden Blood Clot (One That Did Not Produce Symptoms) Has Occurred. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85378. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85378 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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