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See a sample rate comparisonCPT 85549 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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85549 |
| Medicaid Fee Schedule | View Medicaid rates for 85549 |
National average reimbursement for CPT 85549 by major payers:
$16.68
$13.31
$20.77
$27.49
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CPT 85549
5 of 25 sample ratesHigher to lower in this preview
Foundation Bariatric Hospital Of San Antonio, LLC, Foundation Surgical Hospital Of San Antonio
Foundation Bariatric Hospital Of San Antonio, LLC
$52.50Published rateHuntsville Community Hospital, Inc.
Huntsville Community Hospital Inc
$23.59Published rateTyler Regional Hospital LLC
$18.75Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$11.25Published rateGraham Regional Medical Center, Graham General Hsopital Physicians
$9.72Published rate
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See a sample payer proposalCPT 85549 vs. Other Hematology and Coagulation Procedures Codes
The CPT 85549 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 85549 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 85549. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85549 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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