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See a sample rate comparisonCPT 85380 Fee Schedule
Medicare rates as of January 2026
CPT 85380 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 | $10.18 national lab fee schedule rate (2026) · View Medicare rates for 85380 |
| Medicaid Fee Schedule | $10.055 median of the 8 states in the free preview · View Medicaid rates for 85380 |
National average reimbursement for CPT 85380 by major payers:
$8.96
BCBS / Anthem
$7.04
UnitedHealthcare
$11.20
Aetna
$15.21
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 85380.
CPT 85380
5 of 25 sample ratesHigher to lower in this preview
All Ways Homecare Inc
$40.00Published rateChristopher Raio
St Joseph Hospital
$11.11Published ratePrisma Health-Upstate, Prisma Health Cancer Inst-Grove
Prisma Health - Upstate
$9.15Published rateChristopher Raio
St Joseph Hospital
$6.11Published rateMark Vital
Hea Clinic, P.A., Dba Houston Eye Associates
$4.28Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 85380 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85380. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 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. |
| 85396-CPT | Low | Clotting Assay Whole Blood, Coagulation Fibrinolysis Assay Whole Blood Eg Viscoelastic Clot Assessment Including Use Of Any Pharmacologic Additive S As Indicated Including Interpretation And Written Report Per Day |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85380. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85380 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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