CPT 85384 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 | 21 - Inpatient Hospital 81 - Independent Laboratory |
| Common Modifiers | None 26 - Professional component 91 - Repeat Lab Test |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85384 |
| Medicaid Fee Schedule | View Medicaid rates for 85384 |
National average reimbursement for CPT 85384 by major payers:
$8.24
$6.45
$11.03
$14.45
CPT 85384 vs. Other Hematology and Coagulation Procedures Codes
The CPT 85384 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 85384 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 |
|---|---|---|
| 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. |
| 85384-CPT | Low | Blood Clotting Protein Test, The Factor I Test Measures The Activity Level Of Fibrinogen One Of 20 Proteins Needed For Blood Clotting. It Is Made In The Liver. When An Injury Occurs Fibrinogen Binds To Other Proteins At A Wound Site To Form A Barrier To Prevent Additional Blood Loss. |
| 85385-CPT | Low | Blood Clotting Test, The Fibrinogen Test Is One Of 13 Clotting Factors That Can Be Measured When A Problem Is Suspected. The Test May Follow Up Another Type Of Clotting Test Or It May Be Ordered As Part Of An Evaluation Of The Heart. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85384. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85384 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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