Summary & Overview
CPT 85291: Factor XIII Solubility Screening Test
CPT code 85291 represents a laboratory solubility screening test that evaluates the role of coagulation factor XIII (fibrin stabilizing factor) in clot lysis. This specialized hematology assay informs assessments of clot stability and fibrinolysis, with implications for diagnosing bleeding disorders and guiding further laboratory workup. Nationally, such assays play a niche but important role in coagulation diagnostics and specialized laboratory workflows.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how CPT code 85291 is used in clinical practice, common sites where the service is performed, and the payer landscape relevant to coverage and billing for specialized coagulation testing.
Readers will learn the clinical context for ordering a factor XIII solubility screen, typical service settings, and what to expect in terms of coding and payer engagement. The piece also summarizes available benchmarks and policy-relevant considerations for specialized laboratory services. Data not available in the input is noted where payer-specific coverage details, taxonomies, ICD-10 pairings, and related codes would normally appear.
Billing Code Overview
CPT code 85291 describes a solubility screening test performed by a laboratory analyst to evaluate the possible action of coagulation factor XIII (also called fibrin stabilizing factor) in the process of clot lysis. The procedure assesses the contribution of factor XIII to fibrin stability and the resistance of clots to enzymatic breakdown.
Service type: Laboratory diagnostic test (coagulation/hematology assay)
Typical site of service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A 32-year-old patient presents to the hematology clinic after recurrent mucocutaneous bleeding and delayed wound healing following minor injuries. Initial coagulation screening (PT, aPTT, fibrinogen) is largely unremarkable, but clinical suspicion for a rare fibrin-stabilizing defect remains. The clinician orders specialized coagulation testing including a factor XIII functional assay and a solubility screening test performed by the laboratory using 85291 to assess the stability of fibrin clots. The typical workflow: specimen (citrated plasma or whole blood as local protocol dictates) is collected and sent to the coagulation laboratory; a lab analyst performs the solubility screening test to evaluate factor XIII activity; results are reviewed by the laboratory director and reported to the ordering hematologist. This test is commonly performed in an outpatient specialty clinic or hospital laboratory with hematology/coagulation capabilities and interpreted alongside factor XIII antigen testing, factor assays, and clinical history to guide diagnosis of factor XIII deficiency or dysfunction and to inform further genetic testing or replacement therapy planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional interpretation component separate from the technical lab processing when applicable. |