Summary & Overview
CPT 85220: Factor V (Proaccelerin) Clotting Test
CPT code 85220 identifies a laboratory coagulation assay used to detect the presence and activity of factor V (proaccelerin) in a patient’s serum. This specialized test supports evaluation of bleeding disorders, coagulation factor deficiencies, and perioperative or hemostasis assessments. Nationally, accurate coding of coagulation assays matters for clinical continuity, laboratory billing consistency, and payer coverage determinations.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for factor V testing, typical sites of service where the test is performed, and common billing modifiers associated with laboratory procedures. The publication summarizes payer coverage patterns and benchmarks where available and highlights elements that affect claim processing for specialized coagulation assays.
Readers will learn: what CPT code 85220 represents clinically; how the test fits into laboratory service lines; what payers commonly cover the test; and practical billing considerations such as typical service location and coding context. Data not provided in the input are identified explicitly in respective sections.
Billing Code Overview
CPT code 85220 describes a laboratory clotting test performed to determine the presence of factor V (also known as proaccelerin or labile factor) in a patient’s serum. The procedure involves a lab analyst conducting coagulation testing to assess factor V activity, which can inform diagnoses of bleeding disorders or other coagulation abnormalities.
Service Type: Laboratory / Coagulation Assay
Typical Site of Service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient presents to the hematology clinic with a history of abnormal bleeding during childhood and a recent episode of prolonged bleeding after a dental extraction. The clinician suspects an inherited or acquired coagulation factor deficiency and orders specialized coagulation testing. The laboratory receives a citrated plasma specimen and the lab analyst performs a clotting assay to determine the presence and function of factor V (proaccelerin/labile factor) using a factor V activity assay. The workflow includes specimen accessioning, verification of patient and specimen integrity, running a screening prothrombin time (PT) and activated partial thromboplastin time (aPTT), mixing studies if prolonged, and then a specific factor V assay. Reported results guide hematology consultation for further genetic testing or evaluation for acquired inhibitors, medication review, or treatment planning such as factor replacement or supportive care. Typical site of service is an outpatient hospital laboratory, independent clinical laboratory, or hospital inpatient laboratory when performed for admitted patients.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only for the professional interpretation or reporting component of the test separate from the technical lab work. |
TC |