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See a sample rate comparisonCPT 85999 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Unlisted Hematology Procedure
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 21 - Inpatient Hospital 11 - Office |
| Common Modifiers | None 26 - Professional component Q1 - Routine clinical service provided in a clinical research study |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 85999 |
National average reimbursement for CPT 85999 by major payers:
$1,312.59
$14.47
$7.04
$51.38
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CPT 85999
5 of 25 sample ratesHigher to lower in this preview
Nvap Rehab LLC, Peterson Physical Therapy
$60.00Published rateArun Sherma
University Physician Group
$10.00Published rateFaisal Ridha Al-Timimi
University Physician Group
$10.00Published rateHuntsville Community Hospital, Inc.
Huntsville Community Hospital Inc
$4.55Published rateLamb Healthcare Center
$2.13Published rate
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See a sample payer proposalCPT 85999 vs. Other Hematology and Coagulation Procedures Codes
The CPT 85999 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 85999 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 |
|---|---|---|
| 85999-CPT | High | Unlisted Hematology Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85999. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85999 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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