How much does Medicare pay for CPT 85730?

Medicare allowed an average of $5.88 per service and paid $5.88 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $45.66, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 85730?

Coagulation assessment blood test, plasma or whole blood. It was billed 361,849 times to 299,083 Medicare beneficiaries by 759 providers in 2024.

Does 85730 pay differently in an office than a hospital?

Yes. The allowed amount averaged $5.88 in an office setting and $5.89 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 85730 most?

Clinical Laboratory, with 346,626 services from 450 clinicians. Next are Pathology, Hematology-Oncology, Internal Medicine.

CPT 85730

Coagulation assessment blood test, plasma or whole blood

$5.88Medicare-allowed amount per service, averaged across 361,849 services

Providers submitted

$45.66

Asking price, not received

Medicare allowed

$5.88

The fee schedule figure

Medicare paid

$5.88

Balance is patient coinsurance

Providers submitted an average of $45.66 for this code and Medicare allowed $5.88 — 7.8× 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 $5.88 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $5.88
Hospital / facility: $5.89

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 361,830 services were billed in an office setting and 19 in a facility.

Services: 361,849
Beneficiaries: 299,083
Providers billing it: 759
Total allowed: $2,127,672

What Medicare pays for CPT 85730

Across 361,849 services billed by 759 providers to 299,083 beneficiaries, Medicare allowed an average of $5.88 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 85730

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	346,626	285,728	$5.89	450
Pathology	5,252	4,670	$5.85	27
Hematology-Oncology	2,291	1,768	$5.88	69
Internal Medicine	1,797	1,645	$5.88	57
Family Practice	1,333	1,240	$5.87	25
Cardiology	1,125	946	$5.85	23
Interventional Cardiology	617	557	$5.88	11
Medical Oncology	469	393	$5.86	16
Clinical Cardiac Electrophysiology	400	364	$5.88	10
Urology	342	324	$5.87	12
Gastroenterology	221	198	$5.79	4
Vascular Surgery	219	185	$5.89	7
Orthopedic Surgery	211	207	$5.78	7
Nurse Practitioner	139	131	$5.85	9
General Practice	134	100	$5.89	1

85730 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	78,737	$5.89	$5.89	128
New Jersey	74,276	$5.89	$5.89	40
Florida	47,275	$5.89	$5.89	57
Texas	26,023	$5.89	$5.89	59
New York	23,576	$5.88	$5.89	110
North Carolina	19,802	$5.89	$5.89	18
Arizona	15,015	$5.88	$5.89	5
Ohio	7,074	$5.87	$5.89	16
Maryland	6,463	$5.88	$5.89	20
Illinois	6,039	$5.88	$5.89	42
Alabama	5,256	$5.88	$5.89	6
Tennessee	4,392	$5.87	$5.89	7
Massachusetts	4,167	$5.89	$5.89	14
Nevada	3,969	$5.88	$5.89	4
Georgia	3,963	$5.89	$5.89	5
Pennsylvania	3,628	$5.89	$5.89	14
Hawaii	3,077	$5.87	$5.89	3
Washington	2,744	$5.88	$5.89	10
Puerto Rico	2,653	$5.86	$5.89	51
Virginia	2,639	$5.86	$5.89	9
Kansas	2,567	$5.88	$5.89	7
Minnesota	2,154	$5.87	$5.89	6
Colorado	2,033	$5.89	$5.89	6
Michigan	1,792	$5.88	$5.89	13
Oklahoma	1,411	$5.88	$5.89	5
Wisconsin	1,337	$5.83	$5.89	6
Louisiana	1,233	$5.85	$5.89	18
Connecticut	1,155	$5.88	$5.89	4
Mississippi	1,072	$5.86	$5.89	5
South Carolina	830	$5.89	$5.89	4
Indiana	751	$5.87	$5.89	11
Iowa	723	$5.86	$5.89	6
Oregon	624	$5.87	$5.89	5
Kentucky	611	$5.87	$5.89	10
New Mexico	543	$5.88	$5.89	2
Missouri	455	$5.88	$5.89	5
Arkansas	336	$5.87	$5.89	6
Utah	302	$5.86	$5.87	4
Rhode Island	241	$5.89	$5.89	1
Nebraska	145	$5.85	$5.89	1
New Hampshire	135	$5.89	$5.89	1
South Dakota	107	$5.89	$5.89	2
North Dakota	106	$5.85	$5.89	3
Delaware	104	$5.89	$5.89	2
Idaho	86	$5.89	$5.89	2
Maine	81	$5.89	$5.89	1
U.S. Virgin Islands	81	$5.89	$5.89	3
Alaska	47	$5.89	$5.89	1
Montana	19	$5.89	$5.89	1

Related codes

85732Coagulation assessment blood test$6.33
85705Thromboplastin inhibition (circulating anticoagulant) measurement$9.44

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.