CPT 85576 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 | 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 85576 |
National average reimbursement for CPT 85576 by major payers:
$25.93
$16.35
$28.34
$36.53
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 85576 | $24.90 | 1528027786 - METHODIST HOSPITALS OF DALLAS, METHODIST DALLAS MEDICAL CENTER | 750800661 - METHODIST HOSPITALS OF DALLAS | TX | General Acute Care Hospital (282N00000X) |
United | 85576 | $24.90 | 1255384533 - COLUMBIA MEDICAL CENTER OF LEWISVILLE SUBSIDIARY LP, MEDICAL CITY LEWISVILLE | 621682210 - (TX) DE MARKETING AND SALES | TX | General Acute Care Hospital (282N00000X) |
United | 85576 | $30.01 | 1922058569 - SAN ANTONIO VAMC | 742112082 | TX | General Acute Care Hospital (282N00000X) |
United | 85576 | $10.46 | 1831220904 - METHODIST HOSPITAL PLAINVIEW TEXAS, COVENANT HOSPITAL PLAINVIEW | 752426010 - (TX) METHODIST HOSPITAL PLAINVIEW TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 85576 | $24.90 | 1669752234 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 85576 | $30.01 | 1902855901 - BIG SPRING VAMC | 752510465 | TX | General Acute Care Hospital (282N00000X) |
United | 85576 | $24.90 | 1538522412 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE TRANSMOUNTAIN CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 85576 | $39.77 | 1659559573 - ST LUKES COMMUNITY DEVELOPMENT CORPORATION, ST LUKES SUGAR LAND HOSPITAL | 261947374 - (TX) ST LUKES COMMUNITY DEVELOPMENT CORPORATION-SUGAR LAND | TX | General Acute Care Hospital (282N00000X) |
United | 85576 | $24.90 | 1134166192 - ORTHOPEDIC HOSPITAL LTD, TEXAS ORTHOPEDIC HOSPITAL | 760418502 - (TX) ORTHOPEDIC HOSPITAL LTD | TX | General Acute Care Hospital (282N00000X) |
United | 85576 | $12.28 | 1407191984 - BSA HOSPITAL LLC | 900914340 | TX | General Acute Care Hospital (282N00000X) |
United | 85576 | $24.90 | 1639422504 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL SCHERTZ | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 85576 | $24.90 | 1669752234 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 85576 | $27.38 | 1407947336 - CLHG-VILLE PLATTE LLC, MERCY REGIONAL MEDICAL CENTER | 824681222 | LA | General Acute Care Hospital (282N00000X) |
United | 85576 | $24.90 | 1144203662 - TOPS SPECIALTY HOSPITAL, LTD., TOPS SURGICAL SPECIALTY HOSPITAL | 760246499 - (TX) TOPS SPECIALTY HOSPITAL LTD | TX | General Acute Care Hospital (282N00000X) |
United | 85576 | $39.77 | 1942208616 - ST. LUKE'S COMMUNITY HEALTH SERVICES, ST. LUKE'S THE WOODLANDS HOSPITAL | 760536234 - (TX) ST LUKES COMMUNITY HEALTH SERVICES | 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 85576 vs. Other Pathology and Laboratory Procedures Codes
The CPT 85576 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 85576 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 85576. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85576 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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