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See a sample rate comparisonCPT 85420 Fee Schedule
Medicare rates as of January 2026
CPT 85420 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $6.53 national lab fee schedule rate (2026) · View Medicare rates for 85420 |
| Medicaid Fee Schedule | $6.45 median of the 8 states in the free preview · View Medicaid rates for 85420 |
National average reimbursement for CPT 85420 by major payers:
$5.93
BCBS / Anthem
$4.74
UnitedHealthcare
$9.42
Aetna
$10.43
Cigna
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CPT 85420
5 of 25 sample ratesHigher to lower in this preview
All Ways Homecare Inc
$60.00Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$7.76Published rateNorth Texas, Medical City Alliance
North Texas
$6.53Published rateChristus Health Ark-La-Tex, Christus St. Michael Health System
Christus Trinity Clinic
$3.92Published rateGraham Regional Medical Center, Graham General Hsopital Physicians
$2.74Published rate
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See a sample payer proposalCPT 85420 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85420. Select one to see its fee schedule.
| 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 85420. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85420 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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