RxDoctor Payments Data

CPT 85613

Clotting factor x assessment test, diluted

$9.36Medicare-allowed amount per service, averaged across 54,329 services
Providers submitted
$97.92

Asking price, not received

Medicare allowed
$9.36

The fee schedule figure

Medicare paid
$9.36

Balance is patient coinsurance

Providers submitted an average of $97.92 for this code and Medicare allowed $9.3610.5× 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 $9.36 (100%); the rest is the patient’s coinsurance and deductible.

Services
54,329

Medicare Part B, 2024

Beneficiaries
37,815
Providers billing it
111
Total allowed
$508,519

Services × allowed amount

What Medicare pays for CPT 85613

Across 54,329 services billed by 111 providers to 37,815 beneficiaries, Medicare allowed an average of $9.36 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 85613

SpecialtyServicesBeneficiariesAvg allowedProviders
Clinical Laboratory54,05337,646$9.36107
Pathology13873$9.392
Rheumatology13896$9.192

85613 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
New Jersey11,892$9.37$9.395
North Carolina10,880$9.39$9.393
Arizona6,404$9.38$9.393
California4,700$9.38$9.3910
Texas4,074$9.37$9.3912
Florida3,681$9.39$9.397
New York1,549$9.38$9.393
Georgia1,273$9.39$9.391
Colorado1,109$9.39$9.393
Tennessee876$9.27$9.392
Illinois835$9.39$9.395
Minnesota785$9.36$9.393
Ohio705$8.30$9.396
Kansas650$9.38$9.394
Wisconsin628$9.11$9.392
Massachusetts587$9.39$9.393
Pennsylvania483$9.36$9.395
Nevada409$9.39$9.391
Oklahoma398$9.38$9.393
Utah376$9.39$9.393
Alabama370$9.31$9.392
Maryland324$9.39$9.395
Washington275$9.30$9.393
Hawaii267$9.34$9.392
Virginia162$9.38$9.393
New Mexico160$9.34$9.391
Iowa121$9.39$9.392
Maine105$9.39$9.391
Rhode Island66$9.39$9.391
Kentucky50$9.20$9.392
Oregon46$9.24$9.392
Indiana34$9.39$9.391
Connecticut28$9.12$9.391
South Dakota27$9.08$9.391

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.