Summary & Overview
CPT 85613: Russell’s Viper Venom Clotting Time Assay
CPT code 85613 denotes a specialized laboratory assay that measures the impact of Russell’s viper venom at defined concentrations on patient blood clotting time. This test is relevant for toxicology evaluation, research on envenomation effects, and specialized hemostasis testing. Nationally, such assays are uncommon but important where snakebite management, antivenom effectiveness studies, or rare coagulation investigations are performed.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The summary addresses typical payer considerations for specialized laboratory services and situates 85613 within clinical and billing workflows.
Readers will learn what CPT code 85613 represents, the clinical context for ordering the test, and the typical service setting. Coverage and reimbursement benchmarks, relevant billing and coding considerations, and any recent policy updates affecting specialty coagulation assays are summarized where available. Where specific input data are missing, the publication indicates that Data not available in the input rather than inferring details. The goal is to provide clinicians, laboratory managers, and billing professionals with a concise national overview of the code’s purpose and administrative context.
Billing Code Overview
CPT code 85613 describes a laboratory procedure in which a lab analyst evaluates the effect of specified concentrations of Russell’s viper venom on patient blood clotting time. This test assesses how the venom alters coagulation, producing data used in specialized toxicology, hemostasis, or antivenom evaluation contexts.
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Service type: Specialized coagulation/toxicology laboratory assay
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Typical site of service: Hospital or independent clinical laboratory with specialized toxicology and coagulation testing capabilities
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an emergency department or inpatient unit after an envenomation from a suspected Russell’s viper bite, or a patient referred to a hospital laboratory for evaluation of antivenom potency and neutralization studies. The treating team documents local tissue injury, systemic signs (coagulopathy, bleeding, hypotension), and orders laboratory testing to assess venom-induced consumption coagulopathy and to guide antivenom therapy. A blood specimen is collected by phlebotomy and delivered to a clinical or reference laboratory with hematology/coagulation capabilities. The laboratory analyst performs 85613 to measure the effect of graded concentrations of Russell’s viper venom on patient plasma clotting time, interpreting results in the context of fibrinogen levels, prothrombin time (PT), activated partial thromboplastin time (aPTT), platelet count, and clinical findings. Results are reported to the treating clinician to support decisions about antivenom dosing, monitoring for recurrent coagulopathy, and disposition. Typical site of service is a hospital laboratory or specialized reference laboratory; the service type is specialized coagulation/toxicology laboratory testing. The typical patient scenario includes urgent testing for an acute snakebite with suspected or confirmed Russell’s viper envenomation and for research or lot-release testing in public health or antivenom production settings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 |