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See a sample rate comparisonCPT 85475 Fee Schedule
Medicare rates as of January 2026
CPT 85475 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
Hemolysin Bacteria Toxin Test, Hemolysins Are Proteins Created By Bacteria That Cause Red Blood Cells To Fall Apart. This Releases Iron That The Bacteria Feed Upon. The Test Indicates The Presence Of This Type Of Bacteria.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Complexity Level | Low |
| Medicare Fee Schedule | $8.87 national lab fee schedule rate (2026) · View Medicare rates for 85475 |
| Medicaid Fee Schedule | $8.76 median of the 8 states in the free preview · View Medicaid rates for 85475 |
National average reimbursement for CPT 85475 by major payers:
$8.05
BCBS / Anthem
$6.08
UnitedHealthcare
$9.71
Aetna
$13.59
Cigna
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CPT 85475
5 of 25 sample ratesHigher to lower in this preview
Restorative Health Rehabilitation Inc
$55.00Published rateMatthew Lilley
Bend Memorial Clinic, PC
$13.31Published ratePelham Medical Center
$8.86Published ratePrisma Health-Upstate, Prisma Health Op Surgery Patewood
Prisma Health - Upstate
$7.98Published rateTitus County Hospital District, Titus Regional Medical Center
$3.73Published rate
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See a sample payer proposalCPT 85475 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85475. 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. |
| 85475-CPT | Low | Hemolysin Bacteria Toxin Test, Hemolysins Are Proteins Created By Bacteria That Cause Red Blood Cells To Fall Apart. This Releases Iron That The Bacteria Feed Upon. The Test Indicates The Presence Of This Type Of Bacteria. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85475. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85475 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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