Billing code 85396: Clotting assayMedicare rate & RVUs in Massachusetts
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 doesn’t publish an office rate for 85396 in Massachusetts.
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 9 sections
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 in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston | Unavailable | $16.70 |
| Rest Of Massachusetts | Unavailable | $15.91 |
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
Work0.36
0.36 RVUs× 1.000 GPCI
Practice expense0.09
0.09 RVUs× 1.000 GPCI
Malpractice0.02
0.02 RVUs× 1.000 GPCI
Adjusted RVUs
0.4700
Conversion factor
$33.4009
Medicare rate
$15.70
Every GPCI starts 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).
POS 11 · non-facility rate · national
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85396 isn’t priced in this setting.
85396 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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