Summary & Overview
CPT 83605: Lactate Measurement in Blood or Plasma
CPT code 83605 designates a laboratory assay that measures lactate (lactic acid) levels in blood or plasma. Lactate measurement is clinically important for assessing tissue hypoxia, metabolic disturbances, sepsis severity, and monitoring response to therapy in critically ill patients. As a common laboratory chemistry test, lactate measurement has broad national relevance across acute care, emergency, and inpatient settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for lactate testing, typical sites of service, and payer coverage landscape. The publication summarizes reimbursement benchmarks where available, common billing modifiers associated with laboratory services, and coding considerations relevant to billing and claims processing.
This resource provides clinicians, laboratory managers, and billing professionals with a clear description of what CPT code 83605 represents, why lactate testing matters clinically, and what to expect from payers at a national level. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 83605 describes a laboratory measurement of lactate (lactic acid), most commonly performed on blood or plasma samples. Lactate is the end product of anaerobic carbohydrate metabolism and is produced primarily by skeletal muscle activity.
Service type: Laboratory diagnostic test — biochemical assay
Typical site of service: Clinical laboratory or hospital laboratory processing blood/plasma specimens
Clinical & Coding Specifications
Clinical Context
A 58-year-old male presents to the emergency department with progressive shortness of breath, tachypnea, hypotension, and altered mental status after prolonged exertion and suspected sepsis. The treating team orders a serum lactate measurement to evaluate for tissue hypoperfusion and guide resuscitation. A phlebotomist collects a venous blood sample, which is transported to the central laboratory. A clinical laboratory scientist performs the 83605 assay (lactate measurement) on whole blood or plasma using an automated analyzer. Results are reported to the ordering clinician urgently; serial lactate measurements may be performed to assess response to fluid resuscitation and antibiotics. Typical site of service includes the hospital laboratory supporting the emergency department, intensive care unit, or inpatient wards; outpatient clinics or urgent care centers may also obtain lactate levels when indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation/component if applicable (rare for automated lab assays). |
TC | Technical component |