CPT code 85380: D-dimer, qualitative or semiquantitative2026 Medicare lab fee · Clinical Laboratory Fee Schedule
An ultrasensitive D-dimer assay gives a qualitative or semiquantitative result and is reported during evaluation for suspected venous thromboembolism.
Medicare pays $10.18 for 85380 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
$10.18
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 85380 covers
CPT 85380 identifies an ultrasensitive D-dimer assay that measures fibrin degradation products and reports a qualitative or semiquantitative result. It is used in evaluating suspected venous thromboembolism, including possible deep-vein thrombosis or pulmonary embolism. The result is considered alongside the patient’s presentation and other clinical findings. Clinical laboratories perform and report the assay.
Report 85380 for the ultrasensitive qualitative or semiquantitative D-dimer test performed; 85379 describes quantitative fibrin-degradation-product testing. Medicare pays 85380 only through the Clinical Laboratory Fee Schedule (CLFS). The 2026 national CLFS amount is $10.18, the same amount listed for each year from 2020 through 2025. The national amount applies across states and localities, with no geographic or office/facility adjustment. The test has no separate physician fee schedule payment.
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 85380
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 85380. 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 85380 with status X (excluded by statute), so the test itself is paid only from the CLFS.
85380 on the lab fee schedule since 2020
85380 · CLFS 2026 Q4 (current)
$10.18
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.
85380 compared with similar tests
- 85378D-dimer testQualitative or semiquantitative$9.72
- 85378 describes semiquantitative fibrin-degradation-product testing. Choose 85380 when the assay is the ultrasensitive D-dimer test.
- 85379D-dimerQuantitative assay$10.18
- 85379 describes quantitative fibrin-degradation-product testing; 85380 identifies an ultrasensitive D-dimer assay with a qualitative or semiquantitative result.
- 85362FDP testSemiquantitative slide method$6.89
- 85362 describes fibrin-degradation-product testing. It is distinct from the ultrasensitive D-dimer assay reported with 85380.
85380 billing questions
How does 85380 differ from 85379?
85380 is for an ultrasensitive D-dimer assay reported qualitatively or semiquantitatively. 85379 is for quantitative fibrin-degradation-product testing.
Does 85380 apply to every D-dimer test?
Use 85380 for the ultrasensitive qualitative or semiquantitative D-dimer test. Select the code that matches the assay and result type performed.
Is 85380 paid under the physician fee schedule?
No. Medicare pays the test through the CLFS, using one national amount across localities and settings.
What distinguishes 85380 from 85378?
85378 describes semiquantitative fibrin-degradation-product testing. 85380 identifies the ultrasensitive D-dimer assay.
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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