CPT 85547 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 |
| Common Modifiers | None PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85547 |
National average reimbursement for CPT 85547 by major payers:
$7.59
$5.77
$9.55
$12.89
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 85547 | $7.73 | 1598798597 - ST. TAMMANY PARISH HOSPITAL SERVICE DISTRICT NO 1, ST. TAMMANY PARISH HOSPITAL | 720478620 | LA | General Acute Care Hospital (282N00000X) |
United | 85547 | $8.60 | 1114473329 - EMERUS BHS SA THOUSAND OAKS LLC, BAPTIST NEIGHBORHOOD HOSPITAL SHAVANO PARK | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 85547 | $8.60 | 1659323772 - COLUMBIA PLAZA MEDICAL CENTER OF FORT WORTH SUBSIDIARY LP, MEDICAL CITY FORT WORTH | 621682202 - (TX) COLUMBIA PLAZA MEDICAL CENTER OF FORT WORTH SUBSIDIARY LP | TX | General Acute Care Hospital (282N00000X) |
United | 85547 | $6.88 | 1851768337 - KELLY RIDGES | 362925195 - ALLERGY & ASTHMA OF DUPAGE, S.C. | IL | Family Nurse Practitioner (363LF0000X) |
United | 85547 | $10.31 | 1609971019 - SCURRY COUNTY HOSPITAL DISTRICT, COGDELL MEMORIAL HOSPITAL | 752403687 - (TX) SCURRY COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 85547 | $3.00 | 1598375651 - E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC, E AND A HEALTHCARE ON THE GO | 832289173 - (FL) E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC | FL | Home Health Agency (251E00000X) |
United | 85547 | $5.05 | 1447317110 - BAPTIST HEALTH CARE, INC., BAPTIST HOME HEALT CARE AND MEDICAL EQUIPMENT | 590657322 - BAPTIST HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 85547 | $4.64 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 85547 | $11.09 | 1588648315 - POINTE COUPEE PARISH HEALTH SERVICES DISTRICT NUMBER ONE, POINTE COUPEE GENERAL HOSPITAL | 721054801 | LA | Critical Access Hospital (282NC0060X) |
United | 85547 | $8.60 | 1295036770 - CRESCENT CITY SURGICAL CENTRE OPERATING COMPANY, L.L.C. | 270508997 - (LA) CRESCENT CITY SURGICAL CENTRE | LA | General Acute Care Hospital (282N00000X) |
United | 85547 | $11.47 | 1730556259 - RAM SAHA | 541581185 - MCV ASSOCIATED PHYSICIANS | TX | General Acute Care Hospital (282N00000X) |
United | 85547 | $3.60 | 1740273994 - ECTOR COUNTY HOSPITAL DISTRICT, MEDICAL CENTER HOSPITAL | 752302928 | TX | General Acute Care Hospital (282N00000X) |
United | 85547 | $7.73 | 1467496802 - ST FRANCIS HOSPITAL, INC., ST. FRANCIS EASTSIDE | 582504530 - (SC) ST FRANCIS HOSPITAL INC | SC | General Acute Care Hospital (282N00000X) |
United | 85547 | $3.60 | 1295736734 - CHRISTUS HEALTH ARK-LA-TEX, CHRISTUS ST. MICHAEL HEALTH SYSTEM | 752749681 - (TX) CHRISTUS HEALTH ARKLATEX | TX | General Acute Care Hospital (282N00000X) |
United | 85547 | $8.60 | 1609135904 - ANDREW CORONA | 922417967 | 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 85547 vs. Other Pathology and Laboratory Procedures Codes
The CPT 85547 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 85547 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 |
|---|---|---|
| 85547-CPT | Low | Test Red Blood Cell Strength, The Test Stresses Red Blood Cells To See Whether They Can Be Deformed Or Punctured. The Test Helps To Determine If There Is Weakness Caused By An External Factor Or If The Cells Are Missing An Element They Need. |
| 85549-CPT | Low | Enzyme Test For Leukemia, The Test Sample Is Either Urine Or Blood And The Enzyme Measured Is Muramidase. Amounts Often Are Elevated In Acute Leukemia. The Enzyme May Also Be Out Of Balance With Other Types Of Leukemia. |
| 85555-CPT | Low | Test Red Blood Cell Strength, This Test Evaluates The Ability Of Red Blood Cells To Withstand A Force That Would Cause Their Membranes To Rupture And The Cell To Fall Apart. |
| 85557-CPT | Low | Hemolytic Anemia Test, This Test Evaluates Red Blood Cells To Find Out How Easily They Will Fall Apart. Hemolytic Anemia Causes Blood Cells To Be Weaker Than Normal. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85547. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85547 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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