How much does Medicare pay for CPT 85305?

Medicare allowed an average of $11.36 per service and paid $11.36 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $192.11, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 85305?

Protein s (clotting inhibitor) level. It was billed 8,261 times to 8,055 Medicare beneficiaries by 51 providers in 2024.

Which specialty bills 85305 most?

Clinical Laboratory, with 8,261 services from 51 clinicians.

CPT 85305

Protein s (clotting inhibitor) level

$11.36Medicare-allowed amount per service, averaged across 8,261 services

Providers submitted

$192.11

Asking price, not received

Medicare allowed

$11.36

The fee schedule figure

Medicare paid

$11.36

Balance is patient coinsurance

Providers submitted an average of $192.11 for this code and Medicare allowed $11.36 — 16.9× 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 $11.36 (100%); the rest is the patient’s coinsurance and deductible.

Services: 8,261
Beneficiaries: 8,055
Providers billing it: 51
Total allowed: $93,845

What Medicare pays for CPT 85305

Across 8,261 services billed by 51 providers to 8,055 beneficiaries, Medicare allowed an average of $11.36 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 85305

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	8,261	8,055	$11.36	51

85305 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	1,863	$11.34	$11.38	3
North Carolina	1,775	$11.38	$11.38	2
Arizona	1,211	$11.36	$11.38	2
Texas	867	$11.38	$11.38	6
Florida	656	$11.38	$11.38	3
California	458	$11.34	$11.38	5
Georgia	219	$11.38	$11.38	1
New York	204	$11.38	$11.38	2
Tennessee	162	$11.38	$11.38	2
Colorado	113	$11.38	$11.38	3
Ohio	113	$11.29	$11.38	2
Kansas	104	$11.29	$11.38	3
Alabama	89	$11.27	$11.38	2
Massachusetts	75	$11.38	$11.38	2
Nevada	73	$11.38	$11.38	1
Illinois	70	$11.38	$11.38	1
Pennsylvania	69	$11.38	$11.38	2
Maryland	43	$11.38	$11.38	2
Washington	28	$11.38	$11.38	2
Oklahoma	27	$11.38	$11.38	2
Utah	20	$11.38	$11.38	1
Wisconsin	11	$11.38	$11.38	1
Virginia	11	$11.38	$11.38	1

Related codes

85379Coagulation function measurement$9.96
85384Fibrinogen (factor 1) activity measurement$9.52
85390Coagulation function screening test$33.93
85306Protein s (clotting inhibitor) measurement$14.99
85385Fibrinogen (factor 1) antigen detection$14.16
85303Protein c antigen (clotting inhibitor) measurement$13.54
85300Antithrombin iii antigen (clotting inhibitor) activity$11.60
85302Protein c, (clotting inhibitor) activity$11.75
85307Activated protein resistance assay$14.99
85301Antithrombin iii antigen (clotting inhibitor) level$10.58
85347Coagulation time measurement$4.18
85362Coagulation function analysis$6.73

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.