85397
No office rateClotting 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.
On this page
CMS RVU26D · Effective 2026-10-01
85396 Clotting assay Medicare reimbursement rates in Delaware
Reports a whole-blood clotting assay, commonly viscoelastic testing, used to assess clot formation and breakdown in settings such as major bleeding or surgery. Compare 85396 office and facility rates across CMS payment localities in Delaware.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 85396 in Delaware?
Delaware has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$15.66
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Coagulation testing
About 85396: Whole-blood clotting assay
Reports a whole-blood clotting assay, commonly viscoelastic testing, used to assess clot formation and breakdown in settings such as major bleeding or surgery.
CPT 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.
Where the value comes from
- Work RVU0.36 · 77%
- Practice expense (office) RVU0.09 · 19%
- Malpractice RVU0.02 · 4%
293
Medicare services in 2024 · #4011 by national volume
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.
85396 compared with similar codes
Office rates for Delaware, from the same CMS release.
85347
No office rateCoagulation 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.
85348
No office rateCoagulation 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.
Compare 85396 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Delaware →
Office / nonfacility
Unavailable
Facility
$15.66
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 85396 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
10,538
- Code
- 85396
- Physician work
- 0.36
- Practice expense
- 0.09
- Malpractice
- 0.02
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.36 | × 1.005 | 0.3618 |
| Practice expense | 0.09 | × 0.988 | 0.0889 |
| Malpractice | 0.02 | × 0.899 | 0.0180 |
| Total RVUs | 0.4687 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$15.66
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.36 | 1.005 |
| Practice expense | 0.09 | 0.988 |
| Malpractice | 0.02 | 0.899 |
(0.36 × 1.005 + 0.09 × 0.988 + 0.02 × 0.899) × $33.4009 = $15.66
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
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10,53985397,,Clotting funct activity,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
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3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503