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See a sample rate comparisonCPT 85611 Fee Schedule
Medicare rates as of January 2026
CPT 85611 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 21 - Inpatient Hospital |
| Common Modifiers | 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $3.94 national lab fee schedule rate (2026) · View Medicare rates for 85611 |
| Medicaid Fee Schedule | $3.89 median of the 8 states in the free preview · View Medicaid rates for 85611 |
National average reimbursement for CPT 85611 by major payers:
$3.55
BCBS / Anthem
$2.82
UnitedHealthcare
$4.86
Aetna
$5.93
Cigna
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CPT 85611
5 of 25 sample ratesHigher to lower in this preview
Da Pediatric Rehabilitation
$40.00Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$3.94Published ratePrisma Health-Upstate, Prisma Health Op Surgery Spartanburg
Prisma Health - Upstate
$3.54Published rateChristopher Raio
Mercy Medical Center
$2.36Published rateBrittany Ptachick
Hroa 401k Plan
$1.65Published rate
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See a sample payer proposalCPT 85611 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85611. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 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. |
| 85611-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. |
| 85612-CPT | Low | Blood Clotting Test, This Test Checks For Deficiencies Of Several Critical Blood Clotting Proteins: Prothrombin Factor V Or Factor X. |
| 85613-CPT | Low | Russell Viper Venom Time Diluted |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85611. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85611 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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