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See a sample rate comparisonCPT 85612 Fee Schedule
Medicare rates as of January 2026
CPT 85612 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
Blood Clotting Test, This Test Checks For Deficiencies Of Several Critical Blood Clotting Proteins: Prothrombin Factor V Or Factor X.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | 26 - Professional component 91 - Repeat Lab Test |
| Complexity Level | Low |
| Medicare Fee Schedule | $17.49 national lab fee schedule rate (2026) · View Medicare rates for 85612 |
| Medicaid Fee Schedule | $16.09 median of the 8 states in the free preview · View Medicaid rates for 85612 |
National average reimbursement for CPT 85612 by major payers:
$13.65
BCBS / Anthem
$9.22
UnitedHealthcare
$17.44
Aetna
$24.81
Cigna
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CPT 85612
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$38.48Published rateChristopher Raio
St Francis Hospital
$20.78Published rateGeorgetown Memorial Hospital, Tidelands Georgetown Memorial Hospital
Georgetown Memorial Hospital
$17.48Published rateChristopher Raio
Mercy Medical Center
$9.44Published rateTitus County Hospital District, Titus Regional Medical Center
$5.48Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 85612 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85612. 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 85612. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85612 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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