Summary & Overview
CPT 85547: Mechanical Hemolysis (Red Cell Fragility) Test
CPT code 85547 denotes a laboratory diagnostic test that measures the degree of hemolysis when red blood cells are subjected to mechanical stress. This functional assay helps characterize mechanically induced red cell destruction and can inform diagnosis of hemolytic anemia related to prosthetic devices, traumatic injury, or intrinsic red cell membrane defects. Nationally, accurate coding and billing of specialized hematology tests like 85547 affects laboratory reporting, clinical decision-making, and payer coverage determinations across varied settings.
Key payers addressed in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical purpose and typical testing site for 85547, plus an outline of what to expect from payer coverage reviews and benchmarking discussions. The publication will cover benchmark payment context, common billing modifiers and coding considerations, and the clinical scenarios where the test is most relevant.
This summary is intended for laboratory managers, billing specialists, clinicians ordering hematology diagnostics, and policy analysts seeking a clear, national-level perspective on CPT code 85547 and its role in hemolysis evaluation and laboratory service delivery.
Billing Code Overview
CPT code 85547 describes a laboratory procedure in which a lab analyst evaluates the degree of hemolysis in a patient blood sample when red blood cells are exposed to mechanical stress. The test assesses red blood cell fragility under controlled mechanical conditions to help identify hemolytic processes related to mechanical trauma or structural red cell abnormalities.
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Service type: Laboratory diagnostic test, mechanical hemolysis/fragility assessment
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Typical site of service: Clinical laboratory or hospital laboratory setting
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred from hematology for evaluation of suspected mechanical hemolysis after a history of progressive anemia, jaundice, elevated lactate dehydrogenase, low haptoglobin, or new-onset hemolysis following placement of a prosthetic heart valve or left ventricular assist device (LVAD). The clinician collects a peripheral blood sample and sends it to the clinical laboratory. In the laboratory, a technologist or lab analyst performs the mechanical fragility assay to subject red blood cells to standardized shear or mechanical stress and measures the degree of hemolysis. Results are reported to the ordering hematologist or cardiothoracic team to help differentiate intravascular hemolysis due to mechanical injury from other causes (autoimmune, enzymatic, or membrane defects) and to guide device assessment or further diagnostic testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician interpretation component if separated from the technical component |
TC | Technical component | When billing only the laboratory technical work and supplies |