CPT 85999: Unlisted Hematology and Coagulation Procedure

Commercial payers pay $6918 on average nationally for this procedure.

CPT code 85999 is an unlisted CPT code used to report hematology and coagulation procedures that do not have a specific code, covering specialized or novel laboratory tests related to blood and clotting function; service type: laboratory/diagnostic hematology and coagulation testing, typical site of service: clinical laboratory or hospital laboratory.

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National Reimbursement Benchmarks

Commercial reimbursement for CPT 85999 is highly heterogeneous. Blue Cross Blue Shield shows the largest dispersion (P75–P25 = $21,745.70 - $20.90 = $21,724.80), driven by extreme high-end payments, while BUCA (average commercial) centers around a mean of $6,918.20 with an interquartile spread of $10,892.80 - $26.70 = $10,865.10, indicating broad variability across commercial contracts. UnitedHealth Group and Cigna present relatively tight commercial bands: UnitedHealth Group’s IQR is $63.00 - $55.00 = $8.00 and Cigna’s IQR is $46.20 - $32.50 = $13.70, reflecting more consistent negotiated rates.

Aetna sits at the low end on central tendency (mean $21.30, median $10.70) with a modest IQR of $10.90 - $10.10 = $0.80, showing unusually narrow mid-market clustering. Blue Cross Blue Shield’s extreme P90 ($43,353.80) and max ($64,999.40) contrast with payers like UnitedHealth Group and Cigna where P90 values are close to their P75s, underscoring where outlier payments inflate overall variability for this code.

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CPT 85999: Unlisted Hematology and Coagulation Procedure

Commercial payers pay $6918 on average nationally for this procedure.

Customize your policy alerts

Sign up for cpt 85999 policy alerts

Get alerted when payer policies referencing 85999 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 62-year-old outpatient with a history of unexplained easy bruising and prolonged bleeding after a dental extraction presents for specialized hematology laboratory testing. The clinician orders an uncommon coagulation panel that includes a specialized platelet function assay and a novel clotting factor activity assay not represented by a specific CPT code. The specimen is collected in the clinic phlebotomy area and sent to a reference laboratory. The laboratory performs the non-routine tests using validated methods and reports quantitative results to the ordering hematologist. Typical workflow: order placement in the electronic medical record, specimen collection and appropriate transport, performance of the specialized hematology/coagulation procedures in the clinical laboratory or reference lab, result verification by a pathologist or clinical laboratorian, and final reporting to the ordering provider. Typical site of service includes hospital outpatient laboratory, independent clinical laboratory, and reference lab. The patient scenario may require coordination of professional and technical components, potential application of modifiers for unusual circumstances, and documentation of medical necessity in the chart.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`85999`	Unlisted hematology and coagulation procedure	Use to report hematology/coagulation procedures that lack a specific CPT code; requires documentation and possible unlisted code rationale.
`85378`	Platelet function analysis, platelet aggregation, each study	Commonly performed alongside specialized platelet function assays; may be ordered if standard aggregation studies are applicable.
`85210`	Platelet function analysis, platelet function testing using flow cytometry	Performed for specialized platelet receptor or flow cytometric platelet function studies that complement or replace unlisted assays.
`85340`	Coagulation inhibitor, factor inhibitor assay (e.g., Bethesda)	Often ordered when unusual clotting behaviors are detected and specialized unlisted coagulation tests are required.
`86803`	Antibody identification (blood bank)	Performed when coagulation abnormalities intersect with transfusion or alloantibody evaluation; may be part of the workflow if transfusion is considered.
`86140`	Immunoassay for infectious agents (e.g., HIV, hepatitis)	May be performed in parallel when bleeding disorders are evaluated for associated infectious causes; included here as a commonly co-ordered lab test.

Related Modifiers

7 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
90	Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…	- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
91	Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…	- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
2080P0202X	Pediatric Cardiology Physician	A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
2080N0001X	Neonatal-Perinatal Medicine Physician	A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with…
207QA0505X	Adult Medicine Physician	The NUCC recommends this code not be used. Choose a more appropriate code.
207SM0001X	Molecular Genetic Pathology (Medical Genetics) Physician	A board certified subspecialty, the molecular genetic pathologist is expert in the principles, theory and technologies of molecular biology and molecu…
1744G0900X	Graphics Designer	Other Service Providers · Specialist
2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	A plastic surgeon with additional training in the investigation, preservation, and restoration by medical, surgical and rehabilitative means of all st…

Related Codes

CPT-85002-BLEEDING-TIME-TEST-LABORATORY

CPT 85002: Bleeding Time Test, Technical Component

CPT-85004-AUTOMATED-DIFFERENTIAL-WHITE-BLOOD-CELL-COUNT

CPT 85004: Automated White Blood Cell Differential

CPT-85007-MANUAL-DIFFERENTIAL-WHITE-BLOOD-CELL-COUNT

CPT 85007: Manual Differential White Blood Cell Count

CPT-85008-BLOOD-SMEAR-MORPHOLOGIC-REVIEW-NO-DIFFERENTIAL

CPT 85008: Microscopic Blood Smear Examination, No Differential

CPT-85009-MANUAL-WBC-COUNT-BUFFY-COAT

CPT 85009: Manual White Blood Cell Count Using Buffy Coat

CPT-85013-MICROHEMATOCRIT-TEST-LABORATORY-DIAGNOSTIC

CPT 85013: Microhematocrit Test by Tube Centrifugation

CPT-85014-HEMATOCRIT-VOLUME-PERCENT-RED-BLOOD-CELLS

CPT 85014: Hematocrit (Volume Percent of Red Blood Cells)

CPT-85018-HEMOGLOBIN-ASSAY-WHOLE-BLOOD

CPT 85018: Hemoglobin Measurement in Whole Blood

CPT-85025-COMPLETE-BLOOD-COUNT-CBC

CPT 85025: Complete Blood Count (CBC)

CPT-85027-COMPLETE-BLOOD-COUNT-HGB-HCT

CPT 85027: Complete Blood Count with Hemoglobin and Hematocrit

Showing 1–10 of 99

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`85999`	Unlisted hematology and coagulation procedure	Use to report hematology/coagulation procedures that lack a specific CPT code; requires documentation and possible unlisted code rationale.
`85378`	Platelet function analysis, platelet aggregation, each study	Commonly performed alongside specialized platelet function assays; may be ordered if standard aggregation studies are applicable.
`85210`	Platelet function analysis, platelet function testing using flow cytometry	Performed for specialized platelet receptor or flow cytometric platelet function studies that complement or replace unlisted assays.
`85340`	Coagulation inhibitor, factor inhibitor assay (e.g., Bethesda)	Often ordered when unusual clotting behaviors are detected and specialized unlisted coagulation tests are required.
`86803`	Antibody identification (blood bank)	Performed when coagulation abnormalities intersect with transfusion or alloantibody evaluation; may be part of the workflow if transfusion is considered.
`86140`	Immunoassay for infectious agents (e.g., HIV, hepatitis)	May be performed in parallel when bleeding disorders are evaluated for associated infectious causes; included here as a commonly co-ordered lab test.

Related Modifiers

7 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
90	Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…	- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
91	Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…	- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
2080P0202X	Pediatric Cardiology Physician	A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
2080N0001X	Neonatal-Perinatal Medicine Physician	A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with…
207QA0505X	Adult Medicine Physician	The NUCC recommends this code not be used. Choose a more appropriate code.
207SM0001X	Molecular Genetic Pathology (Medical Genetics) Physician	A board certified subspecialty, the molecular genetic pathologist is expert in the principles, theory and technologies of molecular biology and molecu…
1744G0900X	Graphics Designer	Other Service Providers · Specialist
2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	A plastic surgeon with additional training in the investigation, preservation, and restoration by medical, surgical and rehabilitative means of all st…

Related Codes

CPT-85002-BLEEDING-TIME-TEST-LABORATORY

CPT 85002: Bleeding Time Test, Technical Component

CPT-85004-AUTOMATED-DIFFERENTIAL-WHITE-BLOOD-CELL-COUNT

CPT 85004: Automated White Blood Cell Differential

CPT-85007-MANUAL-DIFFERENTIAL-WHITE-BLOOD-CELL-COUNT

CPT 85007: Manual Differential White Blood Cell Count

CPT-85008-BLOOD-SMEAR-MORPHOLOGIC-REVIEW-NO-DIFFERENTIAL

CPT 85008: Microscopic Blood Smear Examination, No Differential

CPT-85009-MANUAL-WBC-COUNT-BUFFY-COAT

CPT 85009: Manual White Blood Cell Count Using Buffy Coat

CPT-85013-MICROHEMATOCRIT-TEST-LABORATORY-DIAGNOSTIC

CPT 85013: Microhematocrit Test by Tube Centrifugation

CPT-85014-HEMATOCRIT-VOLUME-PERCENT-RED-BLOOD-CELLS

CPT 85014: Hematocrit (Volume Percent of Red Blood Cells)

CPT-85018-HEMOGLOBIN-ASSAY-WHOLE-BLOOD

CPT 85018: Hemoglobin Measurement in Whole Blood

CPT-85025-COMPLETE-BLOOD-COUNT-CBC

CPT 85025: Complete Blood Count (CBC)

CPT-85027-COMPLETE-BLOOD-COUNT-HGB-HCT

CPT 85027: Complete Blood Count with Hemoglobin and Hematocrit

Showing 1–10 of 99

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

CPT 85999: Unlisted Hematology and Coagulation Procedure

Sign up for cpt 85999 policy alerts

National Reimbursement Benchmarks

CPT 85999: Unlisted Hematology and Coagulation Procedure

Sign up for cpt 85999 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

When should CPT 85999 be used for hematology and coagulation testing?

What documentation is typically needed when submitting 85999?

In which sites of service is 85999 commonly performed?

Which related CPT codes might be reported alongside or instead of 85999?

What diagnoses commonly justify specialized hematology/coagulation testing reported with 85999?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

When should CPT 85999 be used for hematology and coagulation testing?

What documentation is typically needed when submitting 85999?

In which sites of service is 85999 commonly performed?

Which related CPT codes might be reported alongside or instead of 85999?

What diagnoses commonly justify specialized hematology/coagulation testing reported with 85999?

References