CPT 85400 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 | 11 - Office |
| Common Modifiers | None |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85400 |
| Medicaid Fee Schedule | View Medicaid rates for 85400 |
National average reimbursement for CPT 85400 by major payers:
$7.42
$5.99
$9.15
$12.05
CPT 85400 vs. Other Hematology and Coagulation Procedures Codes
The CPT 85400 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 85400 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 |
|---|---|---|
| 85400-CPT | Low | Blood Clot Absorption Test, This Test Evaluates The Ability Of Plasmin To Break Up A Blood Clot So That It May Be Absorbed Into The Blood And Excreted. Plasmin Is A Limiting Factor That Stops The Clotting Process When A Wound Has Been Closed. |
| 85410-CPT | Low | Blood Test Antiplasmin, This Test Measures Alpha-2 Antiplasmin Which Works In The Completion Of The Blood Clotting Process. |
| 85415-CPT | Low | Blood Clotting Test, This Test Looks For Plasminogen Which Is Present In The Blood Until Plasmin Is Needed To Turn Off The Clotting Process At A Wound. The Amount Is An Indicator Of The Bodys Ability To Perform Normal Healing Processes. |
| 85420-CPT | Low | Blood Clotting Test, This Test Looks For Plasminogen Which Is Present In The Blood Until Plasmin Is Needed To Turn Off The Clotting Process At A Wound. The Amount Is An Indicator Of The Bodys Ability To Perform Normal Healing Processes. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85400. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85400 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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