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See a sample rate comparisonCPT 85610 Fee Schedule
Medicare rates as of January 2026
CPT 85610 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
Test Prothrombin Clotting Time, The Prothrombin Time Test Measures How Well Blood Clots. The Test Commonly Assesses The Effectiveness Of Drugs For Thinning Blood Or Preventing Clots. The Test Also Detects Deficiencies In The Proteins Necessary For Clotting.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 26 - Professional component QW - CLIA Waived Tests |
| Complexity Level | Low |
| Medicare Fee Schedule | $4.29 national lab fee schedule rate (2026) · View Medicare rates for 85610 |
| Medicaid Fee Schedule | $4.235 median of the 8 states in the free preview · View Medicaid rates for 85610 |
National average reimbursement for CPT 85610 by major payers:
$4.00
BCBS / Anthem
$3.82
UnitedHealthcare
$5.32
Aetna
$6.26
Cigna
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CPT 85610
5 of 25 sample ratesHigher to lower in this preview
Masih Lali
Shannon Clinic
$6.65Published rateZeshan Latif
$4.28Published rateMuhammad Abdullah
Ironbound Medical Associates LLC
$2.57Published rateHenry Yu
Alpha Medical Services, Inc.
$2.17Published rateNathaniel Barber
Metropolitan Family Health Network Inc
$2.15Published rate
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See a sample payer proposalCPT 85610 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85610. Select one to see its fee schedule.
| 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. |
| 85610-CPT | Low | Test Prothrombin Clotting Time, The Prothrombin Time Test Measures How Well Blood Clots. The Test Commonly Assesses The Effectiveness Of Drugs For Thinning Blood Or Preventing Clots. The Test Also Detects Deficiencies In The Proteins Necessary For Clotting. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85610. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85610 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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