How much does Medicare pay for CPT 85576?

Medicare allowed an average of $19.24 per service and paid $16.66 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $70.38, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 85576?

Platelet aggregation function test. It was billed 18,532 times to 7,535 Medicare beneficiaries by 110 providers in 2024.

Does 85576 pay differently in an office than a hospital?

Yes. The allowed amount averaged $24.10 in an office setting and $17.23 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 85576 most?

Pathology, with 13,123 services from 63 clinicians. Next are Clinical Laboratory, Neurology, Cardiology.

CPT 85576

Platelet aggregation function test

$19.24Medicare-allowed amount per service, averaged across 18,532 services

Providers submitted

$70.38

Asking price, not received

Medicare allowed

$19.24

The fee schedule figure

Medicare paid

$16.66

Balance is patient coinsurance

Providers submitted an average of $70.38 for this code and Medicare allowed $19.24 — 3.7× 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 $16.66 (87%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $24.10
Hospital / facility: $17.23

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 5,426 services were billed in an office setting and 13,106 in a facility.

Services: 18,532
Beneficiaries: 7,535
Providers billing it: 110
Total allowed: $356,556

What Medicare pays for CPT 85576

Across 18,532 services billed by 110 providers to 7,535 beneficiaries, Medicare allowed an average of $19.24 per service. That is 2.5 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 85576

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pathology	13,123	5,098	$17.27	63
Clinical Laboratory	4,156	1,996	$24.19	37
Neurology	706	133	$24.11	1
Cardiology	193	116	$24.41	2
Internal Medicine	179	143	$24.41	4
Hematology	158	32	$18.23	2
Nurse Practitioner	17	17	$24.41	1

85576 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
Florida	6,296	$17.40	$14.01	19
California	2,764	$20.93	$17.31	12
Texas	1,753	$19.54	$18.24	15
New York	1,371	$22.28	$21.54	6
Ohio	1,003	$17.19	$13.89	12
North Carolina	881	$16.87	$13.51	2
New Jersey	838	$18.55	$13.80	4
Virginia	599	$18.39	$16.23	5
Tennessee	331	$24.34	$24.41	4
Louisiana	322	$24.41	$24.41	1
Nevada	311	$16.89	$13.32	1
Massachusetts	266	$20.74	$17.67	3
Wisconsin	235	$24.31	$24.41	1
Kentucky	232	$16.89	$12.77	2
Utah	203	$17.27	$13.93	2
Minnesota	172	$24.41	$24.41	2
Arizona	164	$23.86	$24.41	1
Illinois	163	$20.09	$19.04	3
Oklahoma	132	$23.61	$23.26	3
Hawaii	91	$24.41	$24.41	1
Washington	90	$22.56	$23.80	3
Georgia	61	$24.41	$24.41	1
Missouri	61	$16.63	$13.13	1
New Mexico	55	$24.41	$24.41	1
Alabama	50	$23.58	$24.41	2
Maryland	49	$24.41	$24.41	1
Puerto Rico	22	$23.86	$24.41	1
Mississippi	17	$24.41	$24.41	1

Related codes

85598Phospholipid test$17.56
85597Platelet function test$17.56
85549White blood cell enzyme activity measurement$18.32

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.