FeeBase
Log inGet started
Menu

Billing code 85396: Clotting assayMedicare rate & RVUs

Reports a whole-blood clotting assay, commonly viscoelastic testing, used to assess clot formation and breakdown in settings such as major bleeding or surgery.

CMS RVU26DEffective Oct 1, 2026109 payment localities293 Medicare services in 2024

Medicare pays $15.70 for 85396 nationally in a facility.

Medicare rate · 85396

Clotting assay

Swap in your local Medicare rate.

Work RVUs
0.36
Total RVUs
0.47
Global days
XXX

National rate · 2026

$15.70

Facility setting, before claim adjustments.

See every locality for 85396 → · Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 10 sections
  1. Medicare rate
  2. What 85396 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 85396 covers

billing code 85396 covers a clotting assay performed on whole blood, commonly a viscoelastic test such as thromboelastography. The test evaluates how a clot forms and changes over time, providing information that can help clinicians assess hemostasis. It may be used during trauma resuscitation, cardiac surgery, liver transplantation, or other episodes of significant bleeding. Testing is generally performed by a clinical laboratory or point-of-care team, with results used by the treating clinician to guide management.

Report 85396 when the documented service is a whole-blood clotting assay, rather than a plasma coagulation test or a different specifically defined clotting-time test. The record should identify the whole-blood assay performed, its clinical purpose, and the resulting findings. Choose the code based on the actual test method and service, not solely on the clinical setting or the fact that a result was used to guide transfusion. The CMS physician fee schedule record assigns work and practice-expense relative value units to this code.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 85396 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

85396 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$15.03
Alaska*Unavailable$21.61
ArizonaUnavailable$15.51
ArkansasUnavailable$14.95
AtlantaUnavailable$15.92
AustinUnavailable$15.82
BakersfieldUnavailable$15.95
Baltimore/Surr. CntysUnavailable$16.27
BeaumontUnavailable$15.38
BrazoriaUnavailable$15.62

85396 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
85396 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 85396 rate is calculated

Each of 85396’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 85396

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 0.36Practice expense 0.09Malpractice 0.02

0.4700 adjusted RVUs×$33.4009 conversion factor=$15.70

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 85396

85396 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Place of service · 85396

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

Non-facility (office) rate · national

—

85396 isn’t priced in this setting.

85396 compared with similar codes

Compare codes

85396 vs 85397 vs 85347 vs 85348: national Medicare rates

Swap in your local Medicare rate.

How to choose

85397Clotting funct activity
Both codes concern whole-blood clotting assessment. Select based on the assay documented; 85397 identifies clotting function, while 85396 identifies a whole-blood clotting assay.
85347Coagulation time activated
85347 is for activated coagulation time by a specified method. Use 85396 for a whole-blood clotting assay such as thromboelastography, not simply because testing occurred during surgery.
85348Coagulation time otr method
85348 identifies activated coagulation time by another method. It is not a substitute for 85396 when the performed service is a whole-blood clotting assay.

Codes related to 85396

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 85396
CodeHow it relatesNational office range
Same family
85397Clotting funct activityRelated whole-blood clotting-function code; distinguish it by the specific assay performed.No office rate
Used instead
85347Coagulation time activatedReports activated coagulation time using a specified method rather than the whole-blood assay represented by 85396.No office rate
85348Coagulation time otr methodReports activated coagulation time by another method; select it when that is the test performed.No office rate
85345Coagulation time lee & whiteReports Lee-White coagulation time, a distinct whole-blood clotting-time test.No office rate

85396 billing questions

When should 85396 be selected instead of an activated clotting-time code?

Use 85396 for the documented whole-blood clotting assay, commonly a viscoelastic assay. Use an activated clotting-time code when that specific activated clotting-time test was performed.

Is thromboelastography a typical example of 85396?

Yes. Thromboelastography is a commonly recognized example of a whole-blood clotting assay reported with this code.

What documentation supports reporting 85396?

Document the whole-blood assay or method performed, the clinical indication, and the findings. The record should support that the service was a clotting assay rather than a different coagulation test.

Can 85396 be used for a plasma-based coagulation test?

No. The code identifies a whole-blood clotting assay; select a code that describes the actual plasma-based test performed.

Is 85396 interchangeable with activated clotting time by another method?

No. Activated clotting-time codes describe that specific test, while 85396 describes a whole-blood clotting assay such as a viscoelastic assay.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 85396PPRRVU2026_Oct_nonQPP.csv, line 10,538 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 85396 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 85396 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →