CPT 85610 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 11 - Office |
| Common Modifiers | None 26 - Professional component QW - CLIA Waived Tests |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85610 |
| Medicaid Fee Schedule | View Medicaid rates for 85610 |
National average reimbursement for CPT 85610 by major payers:
$4.00
$3.82
$5.32
$6.26
CPT 85610 vs. Other Hematology and Coagulation Procedures Codes
The CPT 85610 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 85610 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. |
| 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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