CPT code 85378: D-dimer test, qualitative or semiquantitative2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Qualitative or semiquantitative D-dimer testing identifies fibrin degradation products and is reported when the laboratory does not provide a quantitative result.
Medicare pays $9.72 for 85378 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
$9.72
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 85378 covers
This laboratory test detects D-dimer among fibrin degradation products and reports a qualitative or semiquantitative result. It is used in evaluating suspected venous thromboembolism, including deep vein thrombosis and pulmonary embolism. The result indicates whether D-dimer is detected or gives a semiquantitative assessment rather than a quantitative concentration.
Report 85378 when the assay performed is a qualitative or semiquantitative D-dimer test; use 85379 for quantitative D-dimer testing. Medicare pays 85378 through the CLFS at one national amount in every locality, without geographic or office/facility adjustment. The 2026 national CLFS amount is $9.72, unchanged from 2020 through 2026. The test is excluded from the physician fee schedule and paid only through 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 85378
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 85378. 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 85378 with status X (excluded by statute), so the test itself is paid only from the CLFS.
85378 on the lab fee schedule since 2020
85378 · CLFS 2026 Q4 (current)
$9.72
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.
85378 compared with similar tests
- 85379D-dimerQuantitative assay$10.18
- Both codes concern D-dimer testing. Choose 85378 for qualitative or semiquantitative reporting and 85379 for a quantitative result.
- 85362FDP testSemiquantitative slide method$6.89
- 85378 is for qualitative or semiquantitative D-dimer testing; 85362 is for fibrin degradation products testing.
85378 billing questions
When should 85378 be used instead of 85379?
Use 85378 for a qualitative or semiquantitative D-dimer result. Use 85379 when the laboratory reports a quantitative D-dimer result.
How does 85378 differ from 85362?
85378 identifies qualitative or semiquantitative D-dimer testing; 85362 is for fibrin degradation products testing.
What should the documentation support?
The record should identify the D-dimer test performed and support that the laboratory reported a qualitative or semiquantitative result.
How does Medicare pay for 85378?
Medicare pays the test through the CLFS at one national amount, without locality or office/facility differences. The physician fee schedule excludes the test.
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
Fee sheets · Coming soon
Put 85378 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist