CPT 85390Laboratory

Fibrinolysins screen i&r

CPT code 85390 is a laboratory test that screens for fibrinolysins, proteins in the blood that break down clots. This test helps detect abnormal clot breakdown that may cause excessive bleeding or clotting disorders.

Showing rates for

National Average

Base Medicare rate

$34.29

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.75

PE RVU (NF)

0.29

MP RVU

0.02

Total RVU

1.06

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

Loading bundling edits…

Billing tips

Ensure medical necessity documentation clearly links the fibrinolysins screen to specific clinical indications such as DIC, unexplained bleeding, or monitoring thrombolytic therapy
Impact: Prevents medical necessity denials which account for 30-40% of laboratory test rejections; protects full $34.29 reimbursement
When billing 85390 with other coagulation studies on the same date, verify CPT bundling rules to avoid denials for component testing included in panels
Impact: Prevents bundling denials that could result in 100% payment loss; ensures separate payment when tests are distinct and medically necessary
Use modifier 91 for same-day repeat testing only when clinically necessary for monitoring acute conditions like evolving DIC, and document the medical reason in the order
Impact: Secures additional $34.29 payment for repeat testing; without modifier 91 and documentation, claim will deny as duplicate
Report the exact ICD-10 code(s) that justify the test order rather than screening codes; link to conditions like D65 (DIC), R58 (hemorrhage), or K70-K77 (liver disease)
Impact: Increases clean claim rate by 25-35%; specific diagnosis codes reduce LCD/NCD-related denials
Verify that ordering provider's NPI and specialty are documented; some payers require specific specialty credentials for authorization of coagulation testing
Impact: Prevents authorization and rendering provider denials that delay payment by 30-60 days
Submit claims within 30 days of service; Medicare and most commercial payers have strict timely filing limits for laboratory services

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 85390?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT code 85390 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 85390 is $34.29 for both facility and non-facility settings. This rate is based on 1.06 total RVUs (0.75 work RVU, 0.29 PE RVU, 0.02 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

How do I bill CPT 85390 for repeat testing on the same day?

When performing repeat fibrinolysins screening on the same day for clinical monitoring purposes, append modifier 91 to the second and subsequent tests. You must document the medical necessity for repeat testing, such as monitoring DIC progression or response to treatment in critically ill patients. Without modifier 91, the claim will deny as a duplicate service.

What diagnosis codes support medical necessity for CPT 85390?

Common supporting diagnosis codes include D65 (disseminated intravascular coagulation), D68.9 (coagulation defect, unspecified), R58 (hemorrhage NEC), K70-K77 (liver disease codes), and codes for conditions causing abnormal fibrinolysis. Always link the specific diagnosis documented in the medical record that justifies the test order.

Can CPT 85390 be billed with other coagulation tests on the same day?

Yes, CPT 85390 can be billed with other coagulation studies when medically necessary and not bundled. Common pairings include PT/INR (85610), PTT (85730), and D-dimer (85379). Verify payer-specific bundling edits and ensure each test serves a distinct clinical purpose with proper documentation.

What is the RVU value for CPT code 85390?

CPT 85390 has a total RVU of 1.06 for 2025, consisting of 0.75 work RVU, 0.29 practice expense RVU (both facility and non-facility), and 0.02 malpractice RVU. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

Who can order and perform CPT 85390 testing?

CPT 85390 must be performed in a CLIA-certified laboratory with appropriate complexity certification. The test can be ordered by physicians and qualified non-physician practitioners. Laboratory performance requires qualified personnel meeting CLIA high-complexity testing standards, with interpretation typically by a board-certified pathologist or laboratory director.

What are the most common reasons for CPT 85390 claim denials?

The most common denials include lack of medical necessity (incorrect or non-specific diagnosis codes), duplicate service denials when repeat testing is performed without modifier 91, bundling denials when billed with comprehensive coagulation panels, and missing ordering provider information or signatures. Proper documentation and coding prevent most denials.