Summary & Overview
CPT 85420: Fibrinolytic Plasminogen Activity Test
CPT code 85420 designates a laboratory assay for fibrinolytic plasminogen activity, a functional coagulation test that evaluates the body’s capacity to degrade fibrin clots. This test is used in diagnosing and managing bleeding or thrombotic disorders where plasminogen function is relevant. Nationally, assays like this support clinical decision-making in hematology, perioperative care, and specialty coagulation clinics.
Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical role of the test, typical sites of service, and the context in which the assay is ordered. The publication outlines common reimbursement and billing considerations for laboratories and hospitals and highlights benchmark topics readers can expect, such as utilization patterns, documentation requirements, and coding clarity. If specific payer policies or rates are not available in the input, those details are noted as unavailable.
This summary is intended for laboratory managers, billing professionals, and clinicians who require a clear, national-level description of CPT code 85420, its clinical application, and the operational considerations relevant to billing and service delivery.
Billing Code Overview
CPT code 85420 reports a laboratory assay measuring fibrinolytic plasminogen activity, a functional test of the plasminogen system that reflects the blood's ability to break down fibrin clots. This test is performed and interpreted by a clinical laboratory analyst.
Service type: Laboratory diagnostic test (functional coagulation assay)
Typical site of service: Clinical laboratory or hospital laboratory, including specialized coagulation laboratories.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 56-year-old adult referred to a hospital clinical laboratory from hematology for evaluation of suspected fibrinolytic pathway abnormalities after recurrent bleeding following surgery and an abnormal coagulation panel (prolonged bleeding time, normal platelet count). The clinician orders 85420 to quantify plasminogen activity when there is concern for acquired plasminogen deficiency, hyperfibrinolysis, or to evaluate unexplained bleeding or clot breakdown. Blood is drawn by phlebotomy in the outpatient laboratory or inpatient ward, processed by centrifugation to obtain plasma, and sent to the clinical chemistry/coagulation laboratory. A lab technologist performs the assay and documents results in the laboratory information system; the result is reviewed by a pathologist or hematologist for interpretation. Typical sites of service are hospital outpatient laboratory, independent clinical laboratory, or hospital inpatient laboratory. Turnaround time is usually hours to a day depending on urgency and laboratory workflow. Clinically, results guide diagnosis of fibrinolytic disorders, adjustment of antifibrinolytic therapy, and further hematology consultation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional component (interpretation) by a pathologist for the assay result. |