CPT 85670 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 | Hematology and Coagulation Procedures Pathology and Laboratory Procedures |
| Common Place of Service | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | None 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 85670 |
National average reimbursement for CPT 85670 by major payers:
$5.04
$4.12
$6.93
$8.95
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 85670 | $5.76 | 1144203662 - TOPS SPECIALTY HOSPITAL, LTD., TOPS SURGICAL SPECIALTY HOSPITAL | 760246499 - (TX) TOPS SPECIALTY HOSPITAL LTD | TX | General Acute Care Hospital (282N00000X) |
United | 85670 | $3.39 | 1457358103 - BELLVILLE HOSPITAL DISTRICT, BELLVILLE GENERAL HOSPITAL | 760636528 | TX | General Acute Care Hospital (282N00000X) |
United | 85670 | $6.85 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | 85670 | $5.76 | 1609860360 - OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL, ASSUMPTION COMMUNITY HOSPITAL | 721495500 - (LA) OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL INC | LA | Rural Acute Care Hospital (282NR1301X) |
United | 85670 | $5.76 | 1477805406 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL WESTOVER HILLS | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 85670 | $5.76 | 1730697350 - JACKSONVILLE HOSPITAL LLC, UTHEALTH EAST TEXAS JACKSONVILLE HOSPITAL | 824037220 | TX | General Acute Care Hospital (282N00000X) |
United | 85670 | $5.76 | 1669732178 - AD HOSPITAL EAST, LLC | 475587037 | TX | General Acute Care Hospital (282N00000X) |
United | 85670 | $3.39 | 1447259627 - TYLER COUNTY HOSPITAL DISTRICT | 746067306 | TX | General Acute Care Hospital (282N00000X) |
United | 85670 | $10.99 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 85670 | $3.46 | 1295736734 - CHRISTUS HEALTH ARK-LA-TEX, CHRISTUS ST. MICHAEL HEALTH SYSTEM | 752616977 - CHRISTUS TRINITY CLINIC | TX | General Acute Care Hospital (282N00000X) |
United | 85670 | $18.00 | 1154618742 - VHS HARLINGEN HOSPITAL COMPANY LLC, VALLEY BAPTIST MEDICAL CENTER | 452662980 | TX | General Acute Care Hospital (282N00000X) |
United | 85670 | $3.30 | 1669480323 - KELL WEST REGIONAL HOSPITAL LLC | 752756307 - KELL WEST REGIONAL HOSPITAL, LLC | TX | General Acute Care Hospital (282N00000X) |
United | 85670 | $7.62 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 85670 | $5.76 | 1528026267 - LONGVIEW MEDICAL CENTER LP, LONGVIEW REGIONAL MEDICAL CENTER | 621762420 | TX | General Acute Care Hospital (282N00000X) |
United | 85670 | $8.06 | 1225087794 - AMARILLO VAMC | 751616212 | TX | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 85670 vs. Other Pathology and Laboratory Procedures Codes
The CPT 85670 code is part of the Hematology and Coagulation Procedures services used for Pathology and Laboratory 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 85670 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 |
|---|---|---|
| 85547-CPT | Low | Test Red Blood Cell Strength, The Test Stresses Red Blood Cells To See Whether They Can Be Deformed Or Punctured. The Test Helps To Determine If There Is Weakness Caused By An External Factor Or If The Cells Are Missing An Element They Need. |
| 85549-CPT | Low | Enzyme Test For Leukemia, The Test Sample Is Either Urine Or Blood And The Enzyme Measured Is Muramidase. Amounts Often Are Elevated In Acute Leukemia. The Enzyme May Also Be Out Of Balance With Other Types Of Leukemia. |
| 85670-CPT | Low | Thrombin Time Clot Test, This Test Measures Thrombin Time (The Time It Takes For A Blood Clot To Form). It Also Verifies Correct Dosage Of Heparin And Detects Fibrinogen Conditions. |
| 85675-CPT | Low | Thrombin Time Clot Test, This Test Measures Thrombin Time (The Time It Takes For A Blood Clot To Form). It Also Verifies Correct Dosage Of Heparin And Detects Fibrinogen Conditions. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85670. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85670 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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