Summary & Overview
CPT 85360: Euglobulin Clot Lysis Time Assay
CPT code 85360 represents a specialized laboratory assay that measures euglobulin clot lysis time, assessing the rate at which a clot formed from a patient’s plasma sample is broken down. Nationally, this test is used in the diagnostic evaluation of disorders of fibrinolysis and in selected coagulation workups; its utilization influences laboratory workflow and reimbursement for specialized hemostasis testing.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for 85360, common sites of service, and the service type. The publication provides benchmark considerations for laboratory billing, notes on payer coverage patterns where available, and highlights policy or coding items that affect billing and claims submission for specialized coagulation assays.
The piece is intended for billing managers, laboratory directors, and policy analysts seeking an overview of how CPT code 85360 fits into diagnostic coagulation testing, payer coverage landscape, and operational billing considerations. Data not available in the input are indicated where applicable.
Billing Code Overview
CPT code 85360 describes a laboratory procedure in which a lab analyst measures the time required for a euglobulin clot, formed from a patient’s plasma sample, to undergo fibrinolysis (break down). This test evaluates the fibrinolytic activity of the plasma and is performed on a patient plasma specimen.
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Service type: Diagnostic coagulation/fibrinolysis assay
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Typical site of service: Clinical laboratory or hospital laboratory setting
Clinical & Coding Specifications
Clinical Context
A 52-year-old woman presents to the hematology clinic with a history of unexplained prolonged bleeding after dental extraction and recurrent easy bruising. Initial coagulation screening tests (PT, aPTT, fibrinogen) are borderline or non-diagnostic. The hematologist orders a euglobulin clot lysis time to evaluate fibrinolytic activity. A phlebotomy technician collects a citrated plasma sample and sends it to the core laboratory. The lab analyst performs 85360 by isolating the euglobulin fraction, forming a clot, and measuring the time to clot lysis under standardized conditions. Results are reported to the ordering provider in the electronic medical record; abnormal shortened lysis time suggests primary hyperfibrinolysis, while prolonged or normal lysis time helps guide further testing such as fibrin degradation products, plasminogen levels, or clinical management by the hematology team.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the professional interpretation/reporting of the test is billed separate from the technical lab work. |
| TC | Technical component | Use when only the laboratory technical performance of the test is billed (instrumentation, reagents, tech time).