CPT 85055: Reticulated Platelet Percentage, Laboratory Test

CPT code 85055 denotes a laboratory assay that measures the percentage of reticulated (immature) platelets in a blood specimen. Clinically, this test informs assessment of platelet production and bone marrow activity, aiding diagnosis and management of thrombocytopenia, platelet recovery after therapy, and other hematologic conditions. Nationally, availability of this specialized hematology test affects diagnostic workflows in hospitals and reference laboratories.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines coverage and billing considerations across major commercial insurers and the Medicare program.

Readers will learn the clinical context for ordering CPT code 85055, typical sites of service, and what benchmarks and policy elements are relevant for laboratories and billing teams. The report summarizes expected use cases, payer coverage patterns where available, and operational considerations for performing and reporting the assay. Data not available in the input will be noted where applicable.

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Billing Code Overview

CPT code 85055 describes a laboratory evaluation in which the analyst measures the percentage of reticulated platelets in a blood specimen. This test quantifies immature platelets, providing information on platelet production and turnover.

Service type: Laboratory diagnostic test
Typical site of service: Clinical laboratory or hospital laboratory setting

The code applies when a laboratory performs the analytic procedure to determine reticulated platelet percentage from a patient blood specimen. Data not available in the input.

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CPT 85055: Reticulated Platelet Percentage, Laboratory Test

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Sign up for cpt 85055 policy alerts

Get alerted when payer policies referencing 85055 are released or updated.

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Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

Service type: Laboratory diagnostic test
Typical site of service: Clinical laboratory or hospital laboratory setting

The code applies when a laboratory performs the analytic procedure to determine reticulated platelet percentage from a patient blood specimen. Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 56-year-old individual with thrombocytopenia of unclear etiology admitted for hematology evaluation after routine complete blood count shows low platelet count and symptoms such as petechiae or easy bruising. The hematology team orders reticulated platelet testing to assess marrow platelet production and help differentiate peripheral destruction from decreased production. A phlebotomist collects a peripheral whole blood specimen in EDTA tube and sends it to the clinical laboratory. The lab analyst performs flow cytometry or automated reticulated platelet analysis to determine the percentage of immature (reticulated) platelets. Results are reported to the ordering hematologist and included in the electronic medical record; they contribute to decisions about bone marrow biopsy, immune thrombocytopenia treatment, or supportive care (transfusion) planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D69.6`	Thrombocytopenia, unspecified	Direct indication for reticulated platelet testing to assess platelet production.
`D69.3`	Immune thrombocytopenic purpura	Reticulated platelets help distinguish peripheral destruction from decreased production in ITP.
`D61.9`	Aplastic anemia, unspecified	Low reticulated platelet percentage supports decreased marrow platelet production as seen in aplastic anemia.
`C92.0`	Acute myeloblastic leukemia	Marrow disorders and leukemia can affect platelet production; reticulated platelet testing informs production status.
`D73.3`	Hypersplenism	Hypersplenism can cause peripheral platelet sequestration; reticulated platelets may be normal or elevated depending on production.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`85025`	Blood count; complete (CBC) with automated differential WBC and automated platelet count	Often ordered before or alongside reticulated platelet testing to quantify thrombocytopenia and provide baseline indices.
`85027`	Blood count; automated platelet count, blood film review, and platelet estimate	Alternate platelet quantification method used in parallel to reticulated platelet percentage for clinical correlation.
`85379`	Platelet function testing (e.g., PFA-100)	Performed when platelet function, rather than platelet production, is under evaluation; may occur in the same diagnostic workup.
`85049`	Blood smear, interpretation by a physician (morphology)	Peripheral smear review complements reticulated platelet results to assess platelet morphology and presence of schistocytes or platelet clumping.
`36592`	Collection of blood specimen from an implanted port, excludes lab testing	May be used if the specimen is drawn from a central access device for laboratory testing including reticulated platelets.

Related Modifiers

7 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
90	Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…	- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
91	Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…	- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RH0000X	Hematology (Internal Medicine) Physician	An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
363L00000X	Nurse Practitioner	(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
261QM1300X	Multi-Specialty Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
390200000X	Student in an Organized Health Care Education/Training Program	An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensur…
207RH0003X	Hematology & Oncology Physician	An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy t…
163WP0200X	Pediatric Registered Nurse	Nursing Service Providers · Registered Nurse

Related Codes

CPT-85002-BLEEDING-TIME-TEST-LABORATORY

CPT 85002: Bleeding Time Test, Laboratory

CPT-85004-AUTOMATED-DIFFERENTIAL-WHITE-BLOOD-CELL-COUNT

CPT 85004: Automated Differential White Blood Cell Count

CPT-85007-MANUAL-DIFFERENTIAL-WHITE-BLOOD-CELL-COUNT

CPT 85007: Manual Differential White Blood Cell Count

CPT-85008-BLOOD-SMEAR-MORPHOLOGIC-REVIEW-NO-DIFFERENTIAL

CPT 85008: Blood Smear Morphologic Review Without Differential

CPT-85009-MANUAL-WBC-COUNT-BUFFY-COAT

CPT 85009: Manual White Blood Cell Count Using Buffy Coat

CPT-85013-MICROHEMATOCRIT-TEST-LABORATORY-DIAGNOSTIC

CPT 85013: Microhematocrit Test, Laboratory Diagnostic

CPT-85014-HEMATOCRIT-VOLUME-PERCENT-RED-BLOOD-CELLS

CPT 85014: Hematocrit (Volume Percent of Red Blood Cells)

CPT-85018-HEMOGLOBIN-ASSAY-WHOLE-BLOOD

CPT 85018: Hemoglobin Measurement in Whole Blood

CPT-85025-COMPLETE-BLOOD-COUNT-CBC

CPT 85025: Complete Blood Count (CBC)

CPT-85027-COMPLETE-BLOOD-COUNT-HGB-HCT

CPT 85027: Complete Blood Count with Hemoglobin and Hematocrit

Showing 1–10 of 99

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D69.6`	Thrombocytopenia, unspecified	Direct indication for reticulated platelet testing to assess platelet production.
`D69.3`	Immune thrombocytopenic purpura	Reticulated platelets help distinguish peripheral destruction from decreased production in ITP.
`D61.9`	Aplastic anemia, unspecified	Low reticulated platelet percentage supports decreased marrow platelet production as seen in aplastic anemia.
`C92.0`	Acute myeloblastic leukemia	Marrow disorders and leukemia can affect platelet production; reticulated platelet testing informs production status.
`D73.3`	Hypersplenism	Hypersplenism can cause peripheral platelet sequestration; reticulated platelets may be normal or elevated depending on production.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`85025`	Blood count; complete (CBC) with automated differential WBC and automated platelet count	Often ordered before or alongside reticulated platelet testing to quantify thrombocytopenia and provide baseline indices.
`85027`	Blood count; automated platelet count, blood film review, and platelet estimate	Alternate platelet quantification method used in parallel to reticulated platelet percentage for clinical correlation.
`85379`	Platelet function testing (e.g., PFA-100)	Performed when platelet function, rather than platelet production, is under evaluation; may occur in the same diagnostic workup.
`85049`	Blood smear, interpretation by a physician (morphology)	Peripheral smear review complements reticulated platelet results to assess platelet morphology and presence of schistocytes or platelet clumping.
`36592`	Collection of blood specimen from an implanted port, excludes lab testing	May be used if the specimen is drawn from a central access device for laboratory testing including reticulated platelets.

Related Modifiers

7 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
90	Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…	- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
91	Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…	- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RH0000X	Hematology (Internal Medicine) Physician	An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
363L00000X	Nurse Practitioner	(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
261QM1300X	Multi-Specialty Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
390200000X	Student in an Organized Health Care Education/Training Program	An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensur…
207RH0003X	Hematology & Oncology Physician	An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy t…
163WP0200X	Pediatric Registered Nurse	Nursing Service Providers · Registered Nurse

Related Codes

CPT-85002-BLEEDING-TIME-TEST-LABORATORY

CPT 85002: Bleeding Time Test, Laboratory

CPT-85004-AUTOMATED-DIFFERENTIAL-WHITE-BLOOD-CELL-COUNT

CPT 85004: Automated Differential White Blood Cell Count

CPT-85007-MANUAL-DIFFERENTIAL-WHITE-BLOOD-CELL-COUNT

CPT 85007: Manual Differential White Blood Cell Count

CPT-85008-BLOOD-SMEAR-MORPHOLOGIC-REVIEW-NO-DIFFERENTIAL

CPT 85008: Blood Smear Morphologic Review Without Differential

CPT-85009-MANUAL-WBC-COUNT-BUFFY-COAT

CPT 85009: Manual White Blood Cell Count Using Buffy Coat

CPT-85013-MICROHEMATOCRIT-TEST-LABORATORY-DIAGNOSTIC

CPT 85013: Microhematocrit Test, Laboratory Diagnostic

CPT-85014-HEMATOCRIT-VOLUME-PERCENT-RED-BLOOD-CELLS

CPT 85014: Hematocrit (Volume Percent of Red Blood Cells)

CPT-85018-HEMOGLOBIN-ASSAY-WHOLE-BLOOD

CPT 85018: Hemoglobin Measurement in Whole Blood

CPT-85025-COMPLETE-BLOOD-COUNT-CBC

CPT 85025: Complete Blood Count (CBC)

CPT-85027-COMPLETE-BLOOD-COUNT-HGB-HCT

CPT 85027: Complete Blood Count with Hemoglobin and Hematocrit

Showing 1–10 of 99

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.