How much does Medicare pay for CPT 85390?

Medicare allowed an average of $33.93 per service and paid $26.59 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $104.42, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 85390?

Coagulation function screening test with interpretation and report. It was billed 23,756 times to 17,279 Medicare beneficiaries by 273 providers in 2024.

Does 85390 pay differently in an office than a hospital?

Yes. The allowed amount averaged $20.80 in an office setting and $35.06 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 85390 most?

Pathology, with 18,157 services from 247 clinicians. Next are Hematology, Clinical Laboratory, Hematology-Oncology.

CPT 85390

Coagulation function screening test with interpretation and report

$33.93Medicare-allowed amount per service, averaged across 23,756 services

Providers submitted

$104.42

Asking price, not received

Medicare allowed

$33.93

The fee schedule figure

Medicare paid

$26.59

Balance is patient coinsurance

Providers submitted an average of $104.42 for this code and Medicare allowed $33.93 — 3.1× 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 $26.59 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $20.80
Hospital / facility: $35.06

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 1,886 services were billed in an office setting and 21,870 in a facility.

Services: 23,756
Beneficiaries: 17,279
Providers billing it: 273
Total allowed: $806,041

What Medicare pays for CPT 85390

Across 23,756 services billed by 273 providers to 17,279 beneficiaries, Medicare allowed an average of $33.93 per service. That is 1.4 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 85390

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pathology	18,157	14,455	$34.68	247
Hematology	3,528	1,026	$36.73	5
Clinical Laboratory	1,528	1,342	$18.01	10
Hematology-Oncology	351	328	$34.86	5
General Surgery	192	128	$36.61	6

85390 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
Massachusetts	4,676	$37.02	$26.97	15
New York	3,333	$35.07	$26.75	18
Connecticut	1,880	$36.15	$26.73	10
Illinois	1,649	$35.17	$26.61	20
Texas	1,486	$34.56	$26.94	35
Nevada	1,105	$32.96	$27.02	8
Florida	875	$33.62	$26.80	15
Minnesota	844	$25.58	$21.49	4
North Carolina	815	$28.72	$27.06	4
Ohio	807	$33.34	$26.90	11
California	746	$35.83	$26.40	19
Wisconsin	592	$22.87	$19.37	4
Tennessee	547	$25.06	$21.22	6
Michigan	531	$34.74	$26.46	13
Pennsylvania	517	$36.00	$27.21	9
New Mexico	367	$24.64	$22.73	11
Washington	337	$34.69	$25.27	10
New Jersey	325	$37.60	$27.59	5
Oregon	288	$36.71	$27.38	9
Iowa	282	$32.50	$27.13	8
Arkansas	212	$32.40	$27.58	2
Indiana	207	$33.44	$26.78	5
Hawaii	206	$37.64	$27.24	3
Missouri	189	$28.69	$27.31	4
Georgia	141	$34.88	$25.73	3
Alabama	140	$32.85	$25.07	4
Vermont	131	$34.04	$25.59	4
Nebraska	118	$33.11	$27.11	1
Maine	97	$34.43	$26.88	2
Oklahoma	83	$22.82	$20.11	2
Mississippi	73	$33.68	$27.57	4
Arizona	64	$22.41	$19.85	2
Maryland	55	$34.92	$27.61	1
Delaware	24	$33.74	$26.41	1
New Hampshire	14	$34.92	$25.62	1

Related codes

85379Coagulation function measurement$9.96
85384Fibrinogen (factor 1) activity measurement$9.52
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
85305Protein s (clotting inhibitor) level$11.36
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.