CPT 85557 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 | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 81 - Independent Laboratory 49 - Independent Clinic |
| Common Modifiers | None 90 - Reference Laboratory TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85557 |
| Medicaid Fee Schedule | View Medicaid rates for 85557 |
National average reimbursement for CPT 85557 by major payers:
$12.38
$9.50
$15.54
$20.45
CPT 85557 vs. Other Hematology and Coagulation Procedures Codes
The CPT 85557 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 85557 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 |
|---|---|---|
| 85441-CPT | Low | Heinz Body Blood Test, Heinz Bodies Are Injured Red Blood Cells That Stick To Cell Walls. The Test Is Done To Identify The Problem Which Can Be Caused By Drugs Enzyme Deficiencies Or Inherited Hemoglobin Disorders. |
| 85445-CPT | Low | Heinz Body Blood Test, Heinz Bodies Are Injured Red Blood Cells That Stick To Cell Walls. The Test Is Done To Identify The Problem Which Can Be Caused By Drugs Enzyme Deficiencies Or Inherited Hemoglobin Disorders. |
| 85536-CPT | Low | Red Cell Iron Stain, This Test Adds Prussian Blue Dye To A Blood Sample. The Dye Binds To Iron That Is Not Absorbed By Red Blood Cells. This Condition Suggests Bone Marrow Disorders Or Anemias. |
| 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 85557. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85557 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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