Summary & Overview
CPT 85290: Factor XIII (Fibrin Stabilizing Factor) Clotting Test
CPT code 85290 represents a specialized laboratory coagulation assay used to detect the presence or activity of factor XIII (fibrin stabilizing factor) in serum. This test is clinically important for diagnosing rare coagulation disorders that can lead to impaired clot stability and abnormal bleeding, making the code relevant for hematology, transfusion medicine, and diagnostic laboratory services nationwide. Key national payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the test’s clinical purpose and typical settings, a summary of payer coverage patterns, commonly used modifiers, and practical coding context for laboratory service lines. The publication highlights where CPT code 85290 fits within laboratory workflows and the typical site of service, and it identifies gaps where supplemental billing or documentation guidance may be needed. Data not available in the input will be noted explicitly in the detailed sections.
Billing Code Overview
CPT code 85290 describes a laboratory clotting test performed by a lab analyst to determine the presence of factor XIII (fibrin stabilizing factor) in a patient’s serum. This assay assesses the activity or presence of factor XIII, a coagulation protein essential for final fibrin stabilization during clot formation.
-
Service type: Laboratory coagulation assay
-
Typical site of service: Clinical laboratory or hospital laboratory service area
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient with a history of unexplained delayed wound healing and recurrent soft-tissue bleeding is referred to hematology for evaluation of a suspected congenital or acquired fibrin-stabilizing factor deficiency. The clinician orders a factor XIII assay to determine presence and activity of factor XIII. The patient presents to an outpatient phlebotomy or hospital laboratory service for a blood draw. The sample is processed in the clinical laboratory: serum or plasma is separated, and a clot solubility or quantitative factor XIII activity assay is performed by a laboratory scientist or technologist. Results are reviewed by the laboratory director and communicated to the ordering hematologist for diagnostic confirmation and treatment planning, which may include factor XIII concentrate or antifibrinolytic therapy if deficiency is confirmed. Typical site of service is an outpatient clinical laboratory, hospital laboratory, or specialty coagulation testing center.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation or reporting component by a pathologist/laboratory director. |
TC | Technical component |