Summary & Overview
CPT 85270: Factor XI (PTA) Clotting Test
CPT code 85270 identifies a laboratory clotting test for detection of factor XI (plasma thromboplastin antecedent, PTA) in patient serum. This assay is performed when clinicians investigate bleeding diatheses, abnormal coagulation studies, or suspected inherited factor XI deficiency. As a specific hematology/coagulation test, it factors into lab utilization, diagnostic pathways for bleeding disorders, and payer coverage discussions nationwide.
Key payers in typical coverage analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers can expect an overview of clinical context for factor XI testing, how the test fits into laboratory service lines, and typical sites of service. The publication outlines common billing considerations and lists commonly used modifiers (input provided) for operational clarity. It also highlights what is available and where input data are missing.
This national-level summary does not reference state rules or local contracts. It clarifies clinical purpose, typical ordering scenarios, and the laboratory setting for CPT code 85270, and guides readers to the sections that cover payer coverage, billing modifiers, and coding relationships. Data not provided in the input are noted as such in relevant sections.
Billing Code Overview
CPT code 85270 describes a laboratory clotting assay performed to detect the presence of factor XI (plasma thromboplastin antecedent, PTA) in a patient’s serum. The test is a targeted coagulation study used to evaluate factor XI deficiency or abnormality, contributing to assessment of bleeding disorders and unexplained prolonged clotting times.
Service Type: Laboratory — coagulation/hematology
Typical Site of Service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient with a history of excessive bleeding after minor injuries and a family history of bleeding disorders is referred to a hematology clinic. The clinician orders specialized coagulation testing to evaluate for intrinsic pathway factor deficiencies. A phlebotomy blood draw is performed in an outpatient laboratory or hospital blood-draw station; the specimen is sent to the clinical laboratory. The lab analyst performs a clotting assay specifically to detect and quantify factor XI (plasma thromboplastin antecedent, PTA) activity using patient plasma. Results assist the hematologist in diagnosing factor XI deficiency, guiding perioperative planning, genetic counseling, and targeted management. Typical sites of service include outpatient hospital laboratories, independent clinical reference laboratories, and hospital inpatient laboratories when testing is ordered during admission.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation or supervisory component if separated from technical services. |
TC | Technical component |