How much does Medicare pay for CPT 85246?

Medicare allowed an average of $22.43 per service and paid $22.43 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $234.00, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 85246?

Clotting factor viii (vw factor) antigen. It was billed 6,625 times to 5,936 Medicare beneficiaries by 56 providers in 2024.

Which specialty bills 85246 most?

Clinical Laboratory, with 6,598 services from 55 clinicians. Next are Pathology.

CPT 85246

Clotting factor viii (vw factor) antigen

$22.43Medicare-allowed amount per service, averaged across 6,625 services

Providers submitted

$234.00

Asking price, not received

Medicare allowed

$22.43

The fee schedule figure

Medicare paid

$22.43

Balance is patient coinsurance

Providers submitted an average of $234.00 for this code and Medicare allowed $22.43 — 10.4× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $22.43 (100%); the rest is the patient’s coinsurance and deductible.

Services: 6,625
Beneficiaries: 5,936
Providers billing it: 56
Total allowed: $148,599

What Medicare pays for CPT 85246

Across 6,625 services billed by 56 providers to 5,936 beneficiaries, Medicare allowed an average of $22.43 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 85246

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	6,598	5,911	$22.44	55
Pathology	27	25	$21.97	1

85246 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
New Jersey	1,709	$22.46	$22.48	3
North Carolina	995	$22.46	$22.48	1
Arizona	640	$22.45	$22.48	2
California	590	$22.45	$22.48	5
Florida	525	$22.45	$22.48	5
Texas	388	$22.31	$22.48	6
Tennessee	241	$22.40	$22.48	2
Georgia	190	$22.48	$22.48	1
Minnesota	186	$22.48	$22.48	2
New York	139	$22.48	$22.48	2
Massachusetts	127	$22.48	$22.48	2
Colorado	127	$22.48	$22.48	2
Illinois	106	$22.48	$22.48	1
Utah	93	$22.48	$22.48	1
Washington	92	$22.48	$22.48	3
Kansas	73	$22.22	$22.48	2
Pennsylvania	67	$22.48	$22.48	3
Alabama	61	$22.48	$22.48	2
Nevada	57	$22.48	$22.48	1
Ohio	54	$22.48	$22.48	1
Maryland	38	$22.48	$22.48	2
Wisconsin	36	$20.65	$22.48	1
Oklahoma	27	$22.48	$22.48	2
New Mexico	21	$22.48	$22.48	1
Hawaii	15	$22.48	$22.48	1
Virginia	14	$21.09	$22.48	1
Oregon	14	$22.48	$22.48	1

Related codes

85240Clotting factor viii (ahg) measurement$17.51
85245Clotting factor viii (vw factor) measurement$22.44
85250Clotting factor ix (ptc or christmas) measurement$18.64
85270Clotting factor xi (pta) measurement$17.51
85247Clotting factor viii (von willebrand factor) measurement$22.44
85280Clotting factor xii (hageman) measurement$18.93
85220Clotting factor v (acg or proaccelerin) measurement$17.23
85260Clotting factor x (stuart-prower) measurement$17.52
85210Clotting factor ii prothrombin$12.69

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.