How much does Medicare pay for CPT 85651?

Medicare allowed an average of $4.16 per service and paid $4.16 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $19.11, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 85651?

Red blood cell sedimentation rate, to detect inflammation, non-automated. It was billed 473,883 times to 297,600 Medicare beneficiaries by 2,275 providers in 2024.

Does 85651 pay differently in an office than a hospital?

Yes. The allowed amount averaged $4.16 in an office setting and $4.18 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 85651 most?

Clinical Laboratory, with 259,109 services from 313 clinicians. Next are Rheumatology, Internal Medicine, Family Practice.

CPT 85651

Red blood cell sedimentation rate, to detect inflammation, non-automated

$4.16Medicare-allowed amount per service, averaged across 473,883 services

Providers submitted

$19.11

Asking price, not received

Medicare allowed

$4.16

The fee schedule figure

Medicare paid

$4.16

Balance is patient coinsurance

Providers submitted an average of $19.11 for this code and Medicare allowed $4.16 — 4.6× 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 $4.16 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $4.16
Hospital / facility: $4.18

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 473,738 services were billed in an office setting and 145 in a facility.

Services: 473,883
Beneficiaries: 297,600
Providers billing it: 2,275
Total allowed: $1,971,353

What Medicare pays for CPT 85651

Across 473,883 services billed by 2,275 providers to 297,600 beneficiaries, Medicare allowed an average of $4.16 per service. That is 1.6 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 85651

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	259,109	170,858	$4.17	313
Rheumatology	95,837	45,623	$4.15	261
Internal Medicine	43,980	29,294	$4.17	578
Family Practice	26,176	19,708	$4.15	529
Hematology-Oncology	12,255	8,033	$4.17	157
Cardiology	11,632	6,345	$4.17	37
Nurse Practitioner	7,930	5,527	$4.16	131
Physician Assistant	4,686	3,372	$4.15	93
Medical Oncology	3,245	2,173	$4.17	44
Endocrinology	1,615	1,133	$4.16	17
General Practice	1,466	1,122	$4.16	13
Gastroenterology	1,219	763	$4.18	16
Nephrology	824	413	$4.18	5
Pathology	755	615	$4.17	10
Geriatric Medicine	742	608	$4.18	5

85651 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
California	143,755	$4.16	$4.18	189
New Jersey	57,775	$4.18	$4.18	57
New York	46,974	$4.17	$4.18	307
Florida	28,321	$4.18	$4.18	90
Texas	21,450	$4.14	$4.18	125
Illinois	20,276	$4.17	$4.18	43
Virginia	11,235	$4.17	$4.18	86
Pennsylvania	10,487	$4.16	$4.18	35
Maryland	10,470	$4.16	$4.18	91
North Carolina	8,873	$4.16	$4.18	108
Missouri	7,994	$4.15	$4.18	37
Michigan	7,470	$4.14	$4.18	53
Oregon	7,013	$4.15	$4.18	20
Mississippi	6,988	$4.15	$4.18	61
Massachusetts	6,797	$4.17	$4.18	126
Alabama	6,688	$4.15	$4.18	70
Louisiana	6,580	$4.17	$4.18	32
Georgia	6,491	$4.16	$4.18	66
Indiana	6,360	$4.15	$4.18	32
Oklahoma	4,755	$4.16	$4.18	32
Puerto Rico	4,109	$4.15	$4.18	66
Iowa	4,001	$4.16	$4.18	55
South Carolina	3,806	$4.16	$4.18	63
Nebraska	3,559	$4.16	$4.18	64
Hawaii	3,442	$4.18	$4.18	1
Ohio	3,274	$4.16	$4.18	10
Kansas	3,047	$4.17	$4.18	47
Tennessee	2,989	$4.11	$4.18	47
Arkansas	2,219	$4.15	$4.18	61
Kentucky	1,943	$4.18	$4.18	19
Wisconsin	1,909	$4.15	$4.18	34
Washington	1,771	$4.13	$4.18	13
Alaska	1,636	$4.16	$4.18	17
Utah	1,584	$4.14	$4.18	14
Arizona	1,572	$4.18	$4.18	9
Maine	909	$4.16	$4.18	11
Connecticut	906	$4.17	$4.18	6
Nevada	544	$4.18	$4.18	4
Montana	511	$4.18	$4.18	9
West Virginia	484	$4.16	$4.18	7
Colorado	448	$4.18	$4.18	8
U.S. Virgin Islands	441	$4.18	$4.18	3
Minnesota	364	$4.15	$4.18	9
South Dakota	329	$4.17	$4.18	12
New Mexico	267	$4.18	$4.18	5
Delaware	267	$4.18	$4.18	1
New Hampshire	178	$4.18	$4.18	4
District of Columbia	169	$4.18	$4.18	1
North Dakota	166	$4.18	$4.18	2
Wyoming	159	$4.15	$4.18	6
Idaho	82	$4.18	$4.18	4
Vermont	17	$3.97	$4.18	1
Rhode Island	17	$4.18	$4.18	1
Guam	12	$4.18	$4.18	1

Related codes

85610Blood test, clotting time$4.19
85652Red blood cell sedimentation rate$2.64
85613Clotting factor x assessment test$9.36
85670Thrombin time$5.64
85660Red blood cell sickling measurement$5.39
85611Blood test, clotting time, substitution$3.84

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.