Summary & Overview
CPT 85292: Prekallikrein (Fletcher Factor) Clotting Test
CPT code 85292 represents a specialized laboratory coagulation assay that detects the presence of prekallikrein, also known as Fletcher factor, in patient serum. This test is clinically relevant for evaluating unexplained bleeding or clotting tendencies linked to intrinsic pathway abnormalities and can influence diagnostic pathways for coagulation disorders. Nationally, access to and coverage of specialized coagulation tests like this affect laboratory service availability and diagnostic clarity for patients with rare coagulation factor deficiencies.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the assay, the typical laboratory setting where the service is performed, and which payers commonly cover such specialty coagulation testing. The publication also summarizes benchmarks and policy considerations relevant to billing and reimbursement for niche coagulation assays, highlights coding and billing nuances for CPT code 85292, and outlines areas where payer policies or clinical practice patterns may affect utilization. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 85292 describes a laboratory clotting test performed by a lab analyst to determine the presence of prekallikrein (Fletcher factor) in a patient’s serum. This assay is a specialized coagulation procedure used to evaluate components of the intrinsic coagulation pathway and can assist in diagnosing bleeding or clotting disorders related to prekallikrein deficiency or dysfunction.
Service type: Specialty coagulation laboratory test
Typical site of service: Clinical laboratory or hospital laboratory setting
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient with a history of unexplained prolonged bleeding after a dental extraction is referred to the hematology laboratory for evaluation of intrinsic contact pathway defects. The clinician orders specialized coagulation testing to evaluate factor deficiencies after routine PT and aPTT results show an isolated prolonged activated partial thromboplastin time. The laboratory performs a clotting assay to determine the presence or absence of prekallikrein (Fletcher factor) via 85292. The specimen is collected in a sodium citrate tube, processed for platelet-poor plasma, and analyzed by a trained medical laboratory scientist. Results are reported to the ordering hematologist who integrates the finding with family history, medication review, and other coagulation studies to determine clinical significance and further management such as genetic counseling or specialist referral.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
90 | Reference (outside) laboratory | When the 85292 test was performed by an outside/ref lab and billing requires a reference lab modifier. |
91 |