Summary & Overview
CPT 85280: Factor XII (Hageman Factor) Clotting Assay
CPT code 85280 identifies a laboratory clotting assay to detect factor XII (Hageman factor) in patient serum. As a specialized hematology diagnostic, the test informs evaluation of the intrinsic coagulation pathway and bleeding or clotting disorders. Nationally, accurate coding of such assays supports appropriate clinical interpretation, lab billing consistency, and payer adjudication for specialized coagulation testing.
Key payers relevant to this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on clinical purpose and service setting for the assay, common payer coverage considerations, and what to expect in terms of coding classification. The publication highlights benchmarks and policy-relevant elements such as payer engagement with specialty laboratory tests, documentation expectations, and how this code is positioned within the laboratory service line.
The analysis is intended to help revenue cycle and clinical laboratory professionals understand the clinical role of the assay, common billing considerations, and the landscape of payer coverage nationally. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 85280 describes a laboratory clotting test performed by a lab analyst to determine the presence of factor XII (Hageman factor) in a patient’s serum. This is a specialized coagulation/hematology assay used to evaluate intrinsic pathway components of the clotting cascade.
-
Service type: Laboratory diagnostic test (coagulation factor assay)
-
Typical site of service: Clinical laboratory or hospital laboratory; sample collection may occur in inpatient or outpatient settings.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 42-year-old female with a history of unexplained prolonged activated partial thromboplastin time (aPTT) is referred to the hospital laboratory for coagulation factor testing. The ordering clinician documents suspected intrinsic pathway deficiency after abnormal screening tests and requests specific factor assays including factor XII (Hageman factor) activity. The patient presents to the outpatient phlebotomy suite; a trained phlebotomist collects citrated plasma and delivers specimens to the hematology coagulation laboratory. A clinical laboratory scientist performs a clotting assay to determine the presence and activity level of factor XII using patient plasma and appropriate controls. Results are documented in the laboratory information system and routed to the ordering provider; if abnormal, reflex testing or hematology consultation may be initiated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing the physician interpretation of the test separately from the facility technical component |
TC | Technical component | When billing the laboratory equipment, supplies, and technician time separate from the professional interpretation |