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 | Hematology and Coagulation Procedures Pathology and Laboratory 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 |
National average reimbursement for CPT 85384 by major payers:
$8.24
$6.45
$11.03
$14.45
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 85384 | $4.98 | 1699768705 - GONZALES HEALTHCARE SYSTEMS | 741625013 | TX | General Acute Care Hospital (282N00000X) |
United | 85384 | $9.72 | 1801817135 - BRAZOS VALLEY PHYSICIANS ORGANIZATION,MSO-LLC, THE PHYSICIANS CENTRE | 742862145 - BRAZOS VALLEY PHYSICIANS ORGANIZATIONMSOLLC | TX | General Acute Care Hospital (282N00000X) |
United | 85384 | $5.05 | 1689663007 - THE GOOD SHEPHERD HOSPITAL, INC., CHRISTUS GOOD SHEPHERD MEDICAL CENTER - LONGVIEW | 751041154 - (TX) GOOD SHEPHERD HOSPITAL INC | TX | General Acute Care Hospital (282N00000X) |
United | 85384 | $8.75 | 1083661409 - LALLIE KEMP MEDICAL CTR, LALLIE KEMP REGIONAL MEDICAL CENTER | 726000749 | LA | Critical Access Hospital (282NC0060X) |
United | 85384 | $8.75 | 1043218365 - HOSPITAL SERVICE DISTRICT NO. 1 OF THE PARISH OF ST. MARY, BAYOU BEND HEALTH SYSTEM | 726008504 - (LA) HOSPITAL SERVICE DISTRICT NO 1 OF THE PARISH OF ST MARY | LA | Critical Access Hospital (282NC0060X) |
United | 85384 | $9.72 | 1699726406 - COLUMBIA MEDICAL CENTER OF PLANO SUBSIDIARY LP, MEDICAL CITY PLANO | 621682203 | TX | General Acute Care Hospital (282N00000X) |
United | 85384 | $10.40 | 1831183748 - HOMER MEMORIAL HOSPITAL, CLAIBORNE MEMORIAL MEDICAL CENTER | 720396868 - (LA) HOMER MEMORIAL HOSPITAL | LA | General Acute Care Hospital (282N00000X) |
United | 85384 | $8.75 | 1467496802 - ST FRANCIS HOSPITAL, INC., ST. FRANCIS EASTSIDE | 582504530 - (SC) ST FRANCIS HOSPITAL INC | SC | General Acute Care Hospital (282N00000X) |
United | 85384 | $9.72 | 1891873337 - CLHG, MINDEN MEDICAL CENTER | 824625698 | LA | Rural Acute Care Hospital (282NR1301X) |
United | 85384 | $10.68 | 1245878990 - HUNTSVILLE COMMUNITY HOSPITAL, INC. | 843654542 - (TX) HUNTSVILLE COMMUNITY HOSPITAL INC | TX | General Acute Care Hospital (282N00000X) |
United | 85384 | $4.86 | 1407191984 - BSA HOSPITAL LLC | 900914340 | TX | General Acute Care Hospital (282N00000X) |
United | 85384 | $7.11 | 1972590602 - PALO PINTO COUNTY HOSPITAL DISTRICT, PALO PINTO GENERAL HOSPITAL | 751256948 | TX | General Acute Care Hospital (282N00000X) |
United | 85384 | $6.94 | 1821098286 - TOURO INFIRMARY | 720423659 - (LA) TOURO INFIRMARY | LA | General Acute Care Hospital (282N00000X) |
United | 85384 | $7.23 | 1346611829 - AMARI THOMAS | 300520570 - (TX) METHODIST HOSPITAL | TX | General Acute Care Hospital (282N00000X) |
United | 85384 | $10.76 | 1669480323 - KELL WEST REGIONAL HOSPITAL LLC | 752756307 - KELL WEST REGIONAL HOSPITAL, LLC | TX | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 85384 vs. Other Pathology and Laboratory Procedures Codes
The CPT 85384 code is part of the Hematology and Coagulation Procedures services used for Pathology and Laboratory 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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