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See a sample rate comparisonCPT 85730 Fee Schedule
Medicare rates as of January 2026
CPT 85730 is classified under Pathology and Laboratory Procedures, in the Hematology and Coagulation Procedures subgroup.
Blood Clotting Time, Partial Thromboplastin Time Assesses The Amount Of Time It Takes For Blood To Clot. The Test Screens For Bleeding Conditions And Is Used To Monitor The Dose Of Heparin And Other Blood Thinners.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 21 - Inpatient Hospital 81 - Independent Laboratory |
| Common Modifiers | 26 - Professional component TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | $6.01 national lab fee schedule rate (2026) · View Medicare rates for 85730 |
| Medicaid Fee Schedule | $5.555 median of the 8 states in the free preview · View Medicaid rates for 85730 |
National average reimbursement for CPT 85730 by major payers:
$5.31
BCBS / Anthem
$4.29
UnitedHealthcare
$7.56
Aetna
$8.82
Cigna
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CPT 85730
5 of 25 sample ratesHigher to lower in this preview
Jimmy Morrison
Mainegeneral Health
$11.85Published rateGerald Mank
Blue Ridge Healthcare Medical Group Inc
$5.73Published rateKanak Das
$3.60Published rateHashim Khandwalla
Digestive And Liver Specialists Of Houston
$2.77Published rateJoycelyn Theard
Texas Institute Of Gastroenterology Assoc., P.A.
$2.51Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 85730 vs. Other Hematology and Coagulation Procedures Codes
The table lists codes related to 85730. 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. |
| 85576-CPT | Low | Platelet (Clotting) Test, Platelets Are Red Blood Cells That Clump Together When Blood Clots. This Test Adds A Material To Stimulate Clumping To A Blood Sample And Then Measures How Long Before Clumping Starts And How Well The Cells Stick Together. |
| 85730-CPT | Low | Blood Clotting Time, Partial Thromboplastin Time Assesses The Amount Of Time It Takes For Blood To Clot. The Test Screens For Bleeding Conditions And Is Used To Monitor The Dose Of Heparin And Other Blood Thinners. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85730. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85730 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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Frequently Asked Questions
A CPT (Current Procedural Terminology) code is a five-digit numerical code used to describe medical, surgical, and diagnostic services and procedures. These codes are crucial for healthcare pricing and billing because they standardize the identification of services, allowing for consistent communication between providers, payers (insurance companies), and patients. When you want to find the cost of a specific medical service, knowing its CPT code can help you search for pricing information more accurately.
To find out the cost of a specific medical procedure or service, you can use various resources. For a personalized estimate based on CPT code and location, it is recommended to use tools like Payerprice. Payerprice offers a fee schedule lookup tool that allows users to search with a CPT code and specific location to get an idea of potential costs. You can also contact your insurance provider directly or the healthcare facility where you plan to receive the service.
Healthcare costs can vary significantly due to a multitude of factors. These include geographical location (costs are often higher in urban areas), the type of facility (e.g., hospital vs. outpatient clinic), the specific provider's fees, negotiations with different insurance companies, and even the complexity of individual patient cases. Additionally, varying overhead costs, technology investments, and market competition contribute to price disparities.
The final price you pay for a medical service is influenced by several factors beyond the service's base cost. These include your insurance plan's deductible, copayment, coinsurance, and out-of-pocket maximums. Whether the provider is in-network or out-of-network with your insurance, and any additional services or complications that arise during the procedure, will also affect the total bill. For specific pricing tailored to your situation, using a tool like Payerprice with your CPT code and location can provide valuable insights.
Yes, comparing prices for medical services before choosing a provider is possible and highly recommended. Utilizing online tools designed for price transparency, such as Payerprice, can be very effective. Payerprice allows you to input specific CPT codes and locations to get an estimate of various provider costs, helping you make an informed decision based on both quality and affordability. Additionally, you can directly contact different healthcare facilities or your insurance company to request price estimates for planned procedures.