CPT 85445 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 | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85445 |
National average reimbursement for CPT 85445 by major payers:
$6.31
$4.81
$7.38
$10.03
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 85445 | $2.86 | 1366442600 - MICHAEL JACOBSON | 541958039 - HROA 401K PLAN | VA | Otolaryngology Physician (207Y00000X) |
United | 85445 | $9.35 | 1588654966 - ST. JAMES PARISH HOSP. SERV. DIST. | 726010747 - (LA) ST JAMES PARISH HOSPITAL | LA | Critical Access Hospital (282NC0060X) |
United | 85445 | $3.91 | 1093783391 - CHRISTUS SPOHN HEALTH SYSTEM CORPORATION, CHRISTUS SPOHN HOSPITAL KLEBERG | 760422435 - C H WILKINSON PHYSICIAN NETWORK | TX | General Acute Care Hospital (282N00000X) |
United | 85445 | $4.09 | 1861650780 - CHILDRENS NATIONAL MEDICAL CENTER | 530196580 - CHILDRENS HOSPITAL | DC | Children's Hospital (282NC2000X) |
United | 85445 | $8.68 | 1407947336 - CLHG-VILLE PLATTE LLC, MERCY REGIONAL MEDICAL CENTER | 824681222 | LA | General Acute Care Hospital (282N00000X) |
United | 85445 | $6.13 | 1104057694 - SPECIALISTS HOSPITAL SHREVEPORT, LLC | 208810573 - (LA) SPECIALISTS HOSPITAL SHREVEPORT, L.L.C. | LA | General Acute Care Hospital (282N00000X) |
United | 85445 | $3.68 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 85445 | $6.82 | 1275580938 - CHCA WEST HOUSTON L P, HCA HOUSTON HEALTHCARE WEST | 621801363 - (TX) CHCA WEST HOUSTON L P | TX | General Acute Care Hospital (282N00000X) |
United | 85445 | $15.00 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 85445 | $3.68 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 85445 | $6.82 | 1427472463 - RESOLUTE HOSPITAL COMPANY, LLC, RESOLUTE HEALTH HOSPITAL | 462942963 - (TX) RESOLUTE HOSPITAL COMPANY LLC | TX | General Acute Care Hospital (282N00000X) |
United | 85445 | $6.82 | 1528027786 - METHODIST HOSPITALS OF DALLAS, METHODIST DALLAS MEDICAL CENTER | 750800661 - METHODIST HOSPITALS OF DALLAS | TX | General Acute Care Hospital (282N00000X) |
United | 85445 | $6.82 | 1154618742 - VHS HARLINGEN HOSPITAL COMPANY LLC, VALLEY BAPTIST MEDICAL CENTER | 452662980 | TX | General Acute Care Hospital (282N00000X) |
United | 85445 | $3.68 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 85445 | $9.52 | 1225087794 - AMARILLO VAMC | 751616212 | 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 85445 vs. Other Pathology and Laboratory Procedures Codes
The CPT 85445 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 85445 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 |
|---|---|---|
| 85441-CPT | Low | Heinz Body Blood Test, Heinz Bodies Are Injured Red Blood Cells That Stick To Cell Walls. The Test Is Done To Identify The Problem Which Can Be Caused By Drugs Enzyme Deficiencies Or Inherited Hemoglobin Disorders. |
| 85445-CPT | Low | Heinz Body Blood Test, Heinz Bodies Are Injured Red Blood Cells That Stick To Cell Walls. The Test Is Done To Identify The Problem Which Can Be Caused By Drugs Enzyme Deficiencies Or Inherited Hemoglobin Disorders. |
| 85536-CPT | Low | Red Cell Iron Stain, This Test Adds Prussian Blue Dye To A Blood Sample. The Dye Binds To Iron That Is Not Absorbed By Red Blood Cells. This Condition Suggests Bone Marrow Disorders Or Anemias. |
| 85540-CPT | Low | White Blood Cell Enzyme Test, The Leukocyte Alkaline Phosphatase Test (Lap) Measures The Amount Of Alkaline Phosphatase Enzyme Present In White Blood Cells. This Test Is Done To Aid In The Diagnosis Of Certain Blood Conditions. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85445. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85445 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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