RxDoctor Payments Data

CPT 85379

Coagulation function measurement, d-dimer; quantitative

$9.96Medicare-allowed amount per service, averaged across 127,173 services
Providers submitted
$135.36

Asking price, not received

Medicare allowed
$9.96

The fee schedule figure

Medicare paid
$9.96

Balance is patient coinsurance

Providers submitted an average of $135.36 for this code and Medicare allowed $9.9613.6× 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 $9.96 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility
$9.96
Hospital / facility
$9.98

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 127,157 services were billed in an office setting and 16 in a facility.

Services
127,173

Medicare Part B, 2024

Beneficiaries
103,324
Providers billing it
672
Total allowed
$1,266,643

Services × allowed amount

What Medicare pays for CPT 85379

Across 127,173 services billed by 672 providers to 103,324 beneficiaries, Medicare allowed an average of $9.96 per service. That is 1.2 services per beneficiary, so this is a code patients typically receive more than once. 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 85379

SpecialtyServicesBeneficiariesAvg allowedProviders
Clinical Laboratory113,88292,605$9.97289
Internal Medicine3,3122,243$9.8563
Family Practice2,5112,400$9.88113
Hematology-Oncology2,2381,242$9.9530
Pathology1,8631,752$9.9321
Nurse Practitioner930838$9.9451
Emergency Medicine716701$9.9136
Physician Assistant661641$9.9832
Medical Oncology350215$9.849
Pulmonary Disease161157$9.987
Cardiology145144$9.927
General Practice108103$9.892
Gastroenterology107102$9.551
Interventional Cardiology5451$9.723
Hospitalist4443$9.982

85379 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.

StateServicesAllowedStandardized pmtProviders
California19,415$9.97$9.9865
New Jersey16,273$9.97$9.9820
Texas14,426$9.96$9.9854
North Carolina11,644$9.98$9.9835
Florida7,725$9.97$9.9830
Arizona6,429$9.97$9.9810
New York5,241$9.97$9.9831
Alabama3,962$9.94$9.9821
Ohio3,948$9.96$9.9812
Tennessee3,434$9.93$9.9827
Kansas3,400$9.97$9.9815
Illinois3,350$9.96$9.9839
Washington2,666$9.94$9.9814
Massachusetts2,520$9.98$9.9821
Virginia2,011$9.94$9.9824
Wisconsin1,811$9.86$9.9816
Oklahoma1,738$9.91$9.986
Nevada1,710$9.97$9.985
Maryland1,611$9.97$9.986
Minnesota1,424$9.95$9.9816
Colorado1,302$9.94$9.9811
Pennsylvania1,244$9.97$9.988
Oregon849$9.96$9.986
Hawaii781$9.87$9.983
Iowa745$9.96$9.9816
Nebraska741$9.96$9.9816
Arkansas601$9.89$9.9813
Michigan587$9.98$9.9813
Mississippi581$9.82$9.9824
Indiana534$9.95$9.987
Rhode Island507$9.98$9.981
Georgia491$9.98$9.9810
Louisiana489$9.98$9.987
South Carolina463$9.87$9.9813
Kentucky414$9.87$9.988
New Mexico409$9.96$9.982
Utah311$9.93$9.987
Connecticut280$9.94$9.985
Missouri260$9.98$9.989
South Dakota162$9.89$9.985
Idaho154$9.98$9.983
Wyoming151$9.87$9.984
North Dakota122$9.83$9.982
Montana105$9.98$9.987
Puerto Rico51$9.98$9.981
Maine45$9.98$9.981
West Virginia41$9.98$9.982
Delaware15$9.98$9.981

Related codes

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.