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See a sample rate comparisonCPT 85397 Fee Schedule
Medicare rates as of January 2026
CPT 85397 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
Blood Clot Breakdown Test, Blood Clots Are Made Up Of A Protein Mesh. Testing Measures The Ability Of The Body To Break Down This Mesh After A Wound Heals.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $30.86 national lab fee schedule rate (2026) · View Medicare rates for 85397 |
| Medicaid Fee Schedule | $28.775 median of the 8 states in the free preview · View Medicaid rates for 85397 |
National average reimbursement for CPT 85397 by major payers:
$25.24
BCBS / Anthem
$18.42
UnitedHealthcare
$31.07
Aetna
$66.27
Cigna
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CPT 85397
5 of 25 sample ratesHigher to lower in this preview
Mountainside Family Practice Associates
Atlantic Health System Inc
$41.25Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$30.86Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$18.52Published rateLeon Home Health, LLC, Leon At Home
$13.10Published rateProgressive Emergency Physicians PLLC
$4.34Published rate
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See a sample payer proposalCPT 85397 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85397. Select one to see its fee schedule.
| 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. |
| 85397-CPT | Low | Blood Clot Breakdown Test, Blood Clots Are Made Up Of A Protein Mesh. Testing Measures The Ability Of The Body To Break Down This Mesh After A Wound Heals. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85397. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85397 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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