CPT code 85055: Young platelets, immature platelet measurement2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures young, RNA-rich platelets to help assess platelet production, commonly during evaluation of thrombocytopenia or changes in platelet counts.
Medicare pays $35.74 for 85055 under the 2026 Clinical Laboratory Fee Schedule: one national amount, the same in every state and setting.
Medicare lab fee · CLFS 2026 Q4
National CLFS amount
$35.74
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2020
- Unchanged
- CMS updates
- Quarterly
Medicare pays the lesser of the lab’s charge and this amount. Patients usually owe no Part B deductible or coinsurance for covered clinical lab tests.
On this page 8 sections
What 85055 covers
This assay measures reticulated, or young, platelets in a blood specimen. These platelets retain more RNA than mature platelets, so their measurement can help clinicians assess current platelet production. It may be used during evaluation of thrombocytopenia or changing platelet counts, including to help assess whether low counts reflect reduced production or increased platelet loss. Hematology laboratories perform or report the assay as part of a clinical evaluation alongside other blood tests.
Report 85055 for the reticulated platelet assay; it measures a different platelet characteristic from a total platelet count. Medicare pays the test only under the CLFS. The 2026 national CLFS amount is $35.74, unchanged from 2020 through 2026. The amount is the same across states and localities, with no geographic or office-versus-facility adjustment. The test is paid only from the CLFS.
This summary was written with AI assistance from CMS Clinical Laboratory Fee Schedule data. Amounts on this page come directly from CMS files.
How Medicare pays 85055
Clinical lab tests aren’t priced like physician services. They’re paid from their own fee schedule, with its own rules. See the whole lab fee schedule.
One national amount
CMS sets a single Clinical Laboratory Fee Schedule amount for 85055. There’s no geographic (GPCI) adjustment, so it pays the same in every state and payment locality.
No office or facility rate
Lab tests aren’t built from relative value units, so there’s no office and facility split: the place of service doesn’t change the CLFS amount.
Updated every quarter
CMS republishes the CLFS each quarter. New tests, often proprietary laboratory analyses (PLA codes), join during the year; existing amounts are updated each January.
Excluded from the physician fee schedule
The physician fee schedule lists 85055 with status X (excluded by statute), so the test itself is paid only from the CLFS.
85055 on the lab fee schedule since 2020
85055 · CLFS 2026 Q4 (current)
$35.74
Unchanged since Jan 1, 2020
27 quarterly CLFS releases on file, first CLFS 2020 Q1. A code missing from a quarter wasn’t on that release.
85055 compared with similar tests
- 85049Platelet countAutomated method$4.48
- 85049 reports an automated total platelet count. Use 85055 for the separate measurement of young platelets.
- 85044Reticulocyte countManual method$4.31
- 85044 is a manual reticulocyte count for immature red blood cells. 85055 measures reticulated platelets.
- 85045Reticulocyte countAutomated method$3.99
- 85045 is an automated reticulocyte count for red blood cells, not a measurement of young platelets.
85055 billing questions
How does 85055 differ from a platelet count?
85055 measures young, reticulated platelets. Code 85049 reports an automated total platelet count.
When might a clinician order this assay?
It may be ordered during evaluation of thrombocytopenia or changing platelet counts to help assess platelet production.
Is 85055 the same as a reticulocyte count?
No. 85055 measures young platelets; reticulocyte count codes measure immature red blood cells.
How does Medicare pay for 85055?
Medicare pays it under the CLFS at one national amount across localities, without an office-versus-facility adjustment.
Where this amount comes from
FeeBase reads lab amounts directly from the CMS Clinical Laboratory Fee Schedule file for the quarter: one row per code, with its payment indicator and national amount. Contractor-priced tests are labeled, never given a made-up amount. Amounts are Medicare payment limits, not a patient’s bill or a commercial rate.
CMS CLFS 2026 Q4 · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file line behind this amount
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