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See a sample rate comparisonCPT 85597 Fee Schedule
Medicare rates as of January 2026
CPT 85597 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
Lupus Anticoagulant Test, Three Tests Are Used To Identify A Specific Type Of Clotting Problem Caused By Lupus Anticoagulant. Typically The Tests Are Done As A Series More Than Once To Ensure The Outcome Is Accurate.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $17.98 national lab fee schedule rate (2026) · View Medicare rates for 85597 |
| Medicaid Fee Schedule | $17.755 median of the 8 states in the free preview · View Medicaid rates for 85597 |
National average reimbursement for CPT 85597 by major payers:
$15.53
BCBS / Anthem
$15.48
UnitedHealthcare
$19.80
Aetna
$26.76
Cigna
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CPT 85597
5 of 25 sample ratesHigher to lower in this preview
All Ways Homecare Inc
$60.00Published rateTemple Vamc, Waco Vamc
$25.12Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$17.98Published rateSt Joseph Regional Health Center, St Joseph Ambulatory Surgery
St Joseph Regional Health Center
$16.18Published rateE And A Medical On The Go Healthcare Of South Florida LLC, E And A Healthcare On The Go
E And A Medical On The Go Healthcare Of South Florida LLC
$6.28Published rate
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See a sample payer proposalCPT 85597 vs. Other Hematology and Coagulation Procedures Codes
| Code | Complexity | Description |
|---|---|---|
| 85597-CPT | Low | Lupus Anticoagulant Test, Three Tests Are Used To Identify A Specific Type Of Clotting Problem Caused By Lupus Anticoagulant. Typically The Tests Are Done As A Series More Than Once To Ensure The Outcome Is Accurate. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85597. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85597 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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