Summary & Overview

CPT 85380: Ultrasensitive D-dimer Assay on Patient Plasma

CPT code 85380 designates an ultrasensitive quantitative D-dimer assay performed on patient plasma. D-dimer testing is widely used in the evaluation of thrombotic conditions, including venous thromboembolism and monitoring of coagulation-related disorders. Nationally, D-dimer testing is a common laboratory service that impacts emergency, inpatient, and outpatient diagnostic workflows and can influence downstream imaging and treatment decisions.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for D-dimer testing, typical sites of service where the assay is performed, and the kinds of benchmarks and policy considerations that affect coverage and utilization. The publication outlines common billing and coding considerations, payer coverage patterns, and clinical implications of ultrasensitive testing sensitivity and specificity. It also highlights areas where payers and clinical guidelines intersect, and where policy updates may influence lab utilization and reimbursement. Data not available in the input when specific payer policies, taxonomies, ICD-10 pairings, and related codes are not provided.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 85380D-dimerclinical laboratorydiagnostic testultrasensitive assaylaboratory billingcoagulation testinghematology

Billing Code Overview

CPT code 85380 describes an ultrasensitive quantitative D-dimer test performed on patient plasma. The procedure involves a laboratory analyst using plasma specimens to determine the concentration of D-dimer, a fibrin degradation product used in evaluating thrombotic activity.

Service type: Clinical laboratory diagnostic test (ultrasensitive D-dimer assay)
Typical site of service: Clinical laboratory or hospital laboratory (specimen collected in outpatient or inpatient settings and analyzed in a laboratory)

Clinical & Coding Specifications

Clinical Context

A 58-year-old male presents to the emergency department with acute onset unilateral calf pain and shortness of breath. The emergency physician orders venous duplex ultrasound of the lower extremity and laboratory testing to evaluate for venous thromboembolism. A blood specimen is collected in sodium citrate and sent to the hospital clinical laboratory. The lab analyst performs an ultrasensitive D‑dimer assay on the patient plasma to determine D‑dimer concentration using an automated immunoassay platform. Results are used by the treating team to help rule out pulmonary embolism or deep vein thrombosis when pretest probability is low to moderate. Typical workflow: specimen receipt and accessioning, centrifugation to obtain platelet‑poor plasma, running the ultrasensitive D‑dimer assay, verification of quality controls, and result reporting to the electronic medical record and ordering provider. Typical site of service is the hospital clinical laboratory or an independent clinical laboratory supporting emergency, inpatient, and outpatient settings.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing only the professional interpretation component for split technical/professional services (rare for automated lab assays).
`TC`	Technical component	When billing only the technical component (laboratory performs the test but physician does not bill professional component).
`90`	Reference (outside) laboratory	When the specimen is sent to an outside reference laboratory for testing.
`91`	Repeat clinical diagnostic lab test	When an identical D‑dimer test is repeated on the same day for monitoring or verification.
`59`	Distinct procedural service	When reporting a separate service that is not normally reported together with another service on the same day (use cautiously).
`76`	Repeat procedure by same physician / provider	When the laboratory repeats the assay at the request of the ordering provider and same lab performs it.
`77`	Repeat procedure by another physician / other laboratory	When the repeat test is performed by a different laboratory (Note: `77` is not in the provided list; do not use if absent).
`90`	Reference (outside) laboratory	When specimen is sent to an outside laboratory for testing.
`52`	Reduced services	When the test is partially completed or limited by specimen quality and reduced billing is appropriate.
`53`	Discontinued procedure	When the test could not be completed and is discontinued for documented clinical reasons.
`59`	Distinct procedural service	When another unrelated laboratory service is reported the same day and documentation supports distinctness.

Taxonomy Code	Specialty	Notes
207R00000X	Pathology	Laboratory directors and clinical pathologists overseeing assay validation and interpretation.
207L00000X	Clinical Laboratory	Clinical laboratory technicians and medical technologists performing the assay.
207T00000X	Clinical Toxicology	Laboratories with specialized coagulation/toxicology services that also perform D‑dimer testing.
207K00000X	Hematology	Hematology specialists who may interpret coagulation testing in complex cases.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I26.99`	Other pulmonary embolism without acute cor pulmonale	D‑dimer is used in the diagnostic workup when PE is suspected.
`I82.401`	Acute embolism and thrombosis of unspecified deep veins of right lower extremity	D‑dimer assists in excluding DVT in patients with low to moderate pretest probability.
`R06.02`	Shortness of breath	Symptom prompting D‑dimer testing as part of evaluation for pulmonary embolism.
`R07.9`	Chest pain, unspecified	Chest pain evaluation may include D‑dimer when PE is a consideration.
`I80.201`	Phlebitis and thrombophlebitis of unspecified deep vessels of right lower extremity	D‑dimer may be ordered to support suspicion of thrombotic processes.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`85380`	D‑dimer; ultrasensitive assay	Primary procedure: quantitative ultrasensitive D‑dimer testing on patient plasma.
`36415`	Collection of venous blood by venipuncture	Often performed immediately before `85380` to obtain the specimen for D‑dimer testing.
`85025`	Complete blood count (CBC) with automated differential	Commonly ordered alongside D‑dimer to assess for anemia or infection in the ED workup.
`36416`	Collection of capillary blood specimen	Alternative specimen collection method when venipuncture is difficult; precedes lab testing.
`85610`	Prothrombin time (PT)	Frequently ordered with D‑dimer when evaluating coagulation status in suspected VTE.