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See a sample rate comparisonCPT 85520 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.
Heparin Blood Test, This Test Helps To Manage Low-Dose Heparin Therapy. It Is A Simple Measure Of The Amount Of Heparin Present In A Blood Sample.
| 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 91 - Repeat Lab Test |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85520 |
| Medicaid Fee Schedule | View Medicaid rates for 85520 |
National average reimbursement for CPT 85520 by major payers:
$11.74
$8.91
$16.55
$19.31
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CPT 85520
5 of 25 sample ratesHigher to lower in this preview
Restorative Health Rehabilitation Inc
$60.00Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$17.28Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$13.09Published ratePrisma Health-Upstate, Prisma Health Hillcrest Hospital Vascular Lab
Prisma Health - Upstate
$11.77Published rateBsa Hospital LLC
$5.50Published rate
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See a sample payer proposalCPT 85520 vs. Other Hematology and Coagulation Procedures Codes
The CPT 85520 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 85520 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 |
|---|---|---|
| 85520-CPT | Low | Heparin Blood Test, This Test Helps To Manage Low-Dose Heparin Therapy. It Is A Simple Measure Of The Amount Of Heparin Present In A Blood Sample. |
| 85525-CPT | Low | Removal Of Heparin From Sample, Heparin Is An Anti-Clotting Drug Frequently Given After Surgery. Prior To Testing Blood Heparin Is Removed From The Sample So That Evaluation Of Liver Function Is Accurate. |
| 85530-CPT | Low | Heparin Antidote Tolerance, Protamine Is Given As An Antidote For Too Much Heparin A Blood Thinner Often Given After Surgery. Hypersensitivity Is Common So This Test Is Done To Determine Whether Protamine Can Be Given And How Much Can Be Tolerated. |
| 85576-CPT | Low | Platelet (Clotting) Test, Platelets Are Red Blood Cells That Clump Together When Blood Clots. This Test Adds A Material To Stimulate Clumping To A Blood Sample And Then Measures How Long Before Clumping Starts And How Well The Cells Stick Together. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85520. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85520 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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