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.

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.

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.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the professional interpretation component if instrumentation company bills the technical component separately.
`TC`	Technical component	Use when reporting only the technical component (laboratory processing) performed by the facility or lab.

Taxonomy Code	Specialty	Notes
207RH0000X	Hematology	Hematologists commonly order and interpret reticulated platelet testing.
207RH00000X	Hematology/Oncology	Specialists managing thrombocytopenia and marrow disorders use this test.
208D00000X	Clinical Pathology	Pathologists and clinical laboratory directors oversee laboratory testing and validation.
363L00000X	Laboratory Medicine	Clinical laboratory technologists and lab managers perform/coordinate the assay.
207K00000X	Internal Medicine	Hospitalists and internists frequently order the test as part of inpatient evaluation.

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.

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Summary & Overview