Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 85461 Fee Schedule
Last Verified: September 2026
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.
Fetal Rosette (Rh) Blood Test, The Test Takes A Blood Sample From An Rh-Negative Mother After Delivery. When Stained Any Rh-Positive Red Cells In The Sample Will Form A Rosette. This Indicates If The Newborn Bled During The Birthing.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 26 - Professional component TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85461 |
| Medicaid Fee Schedule | View Medicaid rates for 85461 |
National average reimbursement for CPT 85461 by major payers:
$7.79
$14.19
$9.02
$13.62
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 85461.
CPT 85461
5 of 25 sample ratesHigher to lower in this preview
Restorative Health Rehabilitation Inc
$35.00Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$11.12Published rateWaccamaw Community Hospital, Tidelands Waccamaw Community Hospital
Waccamaw Community Hospital
$9.35Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$6.71Published rateGonzales Healthcare Systems
$3.89Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 85461 vs. Other Hematology and Coagulation Procedures Codes
The CPT 85461 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 85461 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 |
|---|---|---|
| 85460-CPT | Low | Fetal Cell Blood Count, This Test Checks For An Rh Incompatibility Between The Mother And Fetus And Evaluates The Possibility Of Excess Bleeding During Delivery. A Blood Sample From The Mother Is Checked For The Number Of Fetal Blood Cells. |
| 85461-CPT | Low | Fetal Rosette (Rh) Blood Test, The Test Takes A Blood Sample From An Rh-Negative Mother After Delivery. When Stained Any Rh-Positive Red Cells In The Sample Will Form A Rosette. This Indicates If The Newborn Bled During The Birthing. |
| 85651-CPT | Low | Red Blood Cell Test, This Test Measures The Rate At Which Red Blood Cells Sink To The Bottom Of A Test Tube. This Is A Nonspecific Test For Inflammation And Primarily Helps Detect Blood Cell And Vessel Conditions. |
| 85652-CPT | Low | Red Blood Cell Test, This Test Measures The Rate At Which Red Blood Cells Sink To The Bottom Of A Test Tube. This Is A Nonspecific Test For Inflammation And Primarily Helps Detect Blood Cell And Vessel Conditions. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85461. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85461 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 85461) and we'll show you how you compare in 15 minutes or less.