CPT 85610: Medicare rates for 2026
85610: Prothrombin time (PT/INR clotting test) (Lab). Description is our plain-language summary.
Which number to compare to
Match the reference to the kind of charge. A hospital visit often produces two bills: the hospital's facility charge and the doctor's professional charge.
| Kind of charge | 2026 national amount | Notes |
|---|---|---|
| Lab test (lab fee schedule) | $4.29 | National limit amount; local amounts can be lower. Source: CMS Clinical Laboratory Fee Schedule 2026 Q4, national limit. |
| Hospital outpatient facility charge | no separate rate | Status Q4: Conditionally packaged lab test: no separate OPPS payment when billed with other hospital outpatient services; paid under the lab fee schedule when it is the only service. Source: CMS OPPS Addendum B, October 2026, national unadjusted. |
- All amounts are CY2026 national unadjusted rates (PFS RVU26D October release, conversion factor $33.4009; CLFS 2026 Q4; OPPS Addendum B October 2026). Medicare adjusts them by area, so local amounts differ.
- Rates are per unit. If your line shows more than one unit, multiply.
- Modifiers change the reference: -26 and -TC split imaging/tests; repeat modifiers (76, 77, 91) and distinct-service modifiers (59, XE, XS, XP, XU) mean a repeated line can be legitimate.
- Under hospital outpatient rules this code can be packaged: when it's billed with certain other services the same day, Medicare makes no separate payment for it. A hospital may still list a charge for it.
What a higher price means
Hospital and doctor list prices are often several times Medicare. That's usually legal, and it isn't proof of a billing error. What you actually owe depends on your insurance, your plan's negotiated rate, or the provider's self-pay price.
Useful next steps if your charge for 85610 looks high:
- If you're insured, compare the bill with your insurer's Explanation of Benefits (EOB). An in-network provider generally can't bill more than the EOB's patient amount.
- Ask for an itemized bill with codes, dates, units and modifiers (free letter).
- If you're uninsured or self-pay, ask for the self-pay price and the hospital's financial assistance policy. If you got a Good Faith Estimate and the bill is $400+ higher, you may be able to use the No Surprises Act dispute process.
Last checked against CMS files October 14, 2026. Not legal, medical, or financial advice.
Check your whole bill
Possible duplicates and unbundling are shown separately from price comparisons. Scan your bill free