Billing Complete Blood Counts (CBC) CPT code 85025 and 85027

CPT:      Description:


85025 – Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count  – average fee amoount – $10 – $20

85027   Complete Blood Count, automated

A complete blood count consists of measuring a blood specimen for levels of hemoglobin, hematocrit, red blood cells, white blood cells, and platelets. Also, a differential white blood cell (WBC) count measures the percentages of different types of white blood cells. This hematology testing is commonly ordered by physicians to diagnose and treat a wide array of physical disorders. Laboratory test results that show automated CBC as well as the differential WBC support the use of CPT 85025 (provided the physician ordered them).

However, recent Comprehensive Error Rate Testing (CERT) analysis revealed an increase in errors due to incorrect coding for CPT 85025 and 85027. The report shows that the physician’s order is for CBC, not CBC with differential as billed.  Providers are advised to make sure they are completing the tests ordered by the physician and only bill for those exact tests that were ordered.

The report also showed the physician’s order was missing to support medical necessity. The provider may need to contact a third party to obtain the appropriate documentation (i.e. the ordering physician for additional documentation).

CPT codes representing the bundled testing services include: 

85025 Complete CBC, automated (Hgb, Hct, RBC, WBC, and platelet count) and automated WBC differential 85027 Complete CBC, automated (Hgb, Hct, RBC, WBC, and platelet count) National Correct Coding Initiative (NCCI) edits have been established to promote correct coding and prevent inappropriate payments. For example, test codes 85027 and 85004 should not be billed along with code 85025 which represents the bundled testing service.

Further information on the NCCI edits is available at  http://www.cms.hhs.gov/physicians/cciedits/default.asp Based on comments, codes G0306 and G0307 have been established to permit continued billing of common bundled CBC testing services without a platelet count. G0306 Complete (CBC), automated (Hgb, Hct, RBC, WBC, without platelet count) and automated differential WBC count G0307 Complete (CBC), automated (Hgb, Hct, RBC, WBC, without platelet count) If additional CBC component test(s) are medically necessary, only the medically necessary components (e.g. hemoglobin (Hgb) or hematocrit (Hct) ) should be ordered and performed. Billing modifiers can assist in reporting additional medically necessary CBC component test(s) or bundling testing service for the same patient on the same date of service, such as modifier -91 Repeat clinical laboratory test. Organ or Disease Oriented Panel Codes

Similar to prior years, the 2004 pricing amounts for certain organ or disease panel codes and evocative/suppression test codes were derived by summing the lower of the fee schedule amount or the NLA for each individual test code included in the panel code.

The national limitation amount field on the data file is zero-filled.

Mapping Information for New and Revised Codes
New code 84156 is priced at the same rate as code 84155.
New code 84157 is priced at the same rate as code 84155.
New code 85055 is priced at the same rate as code 86361.
New code 87269 is priced at the same rate as code 87272.
New code 87329 is priced at the same rate as code 87328.
New code 87660 is priced at the same rate as code 87470.
New code 89225 is priced at the same rate as deleted code 89355.
New code 89235 is priced at the same rate as deleted code 89365.
New code G0306 is priced at the same rate as code 85025.
New code G0307 is priced at the same rate as code 85027.
New code G0328 is priced at the same rate as code 86318.
New code G0328QW is priced at the same rate as code 86318.



Billing And Coding Guideline

National Correct Coding Initiative (NCCI) edits have been established to promote correct coding and prevent inappropriate payments. For example, test codes 85027 and 85004 should not be billed along with code 85025 which represents the bundled testing service

New code G0306 is priced at the same rate as code 85025.
New code G0307 is priced at the same rate as code 85027.

General Health Panel, 80050

A submission that includes a Comprehensive Metabolic Panel, CPT code 80053, a Thyroid Stimulating  Hormone, CPT code 84443 and one of the following CBC or combination of CBC Component Codes, either CPT codes 85025 or 85027 + 85004 or 85027 + 85007 or 85025 + 85009 by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a General Health Panel, CPT code 80050.

General Health Panel – 80050 (component codes included in panel are 85025, 84443, 80053)

** Medicaid (HCA)
** When codes 85025, 84443 and 80053 are all done on the same encounter, report using the  the general health panel code 80050. Do not report individually; claim will be denied for inappropriate coding.
** Medicare ( HCG)
** Medicare does not cover CPT code 80050.
** When codes 85025, 84443 and 80053 are done on the same encounter, you must report each  code individually.

Multiple Component Blood Tests

The first entry in the Pathology and Laboratory Section of the Current Procedural Terminology (CPT®′) codebook is labeled “Organ or Disease Oriented Panels.” Under the code for each blood panel is an inclusive list of each component code which when grouped together comprise the entire blood panel. CPT indicates that these panels were developed for coding purposes only. The blood panels are:


Code Description

80047 Basic metabolic panel (calcium, ionized)
80048 Basic metabolic panel (calcium, total)
80050 General health panel
80051 Electrolyte panel
80053 Comprehensive metabolic panel
80055 Obstetrical panel
80061 Lipid panel
80069 Renal function panel
80074 Acute hepatitis panel
80076 Hepatic Function Panel

In addition to the blood panels listed above, the global codes for a complete blood count (85025 and 85027) also have multiple code components:

Code Description

85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count

85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)

CPT 85025 CANT Be billed with Below CPT codes

85004 85007 85008 85009 85013 85014 85018 85027 85032 85041 85048 85049 88738 G0306 G0307

CPT 85027 CANT Be billed with Below CPT codes

85004 85008 85013 85014 85018 85032 85041 85048
85049 88738 G0307





Mapping Information for New and Revised Codes

New code 84156 is priced at the same rate as code 84155.

New code 84157 is priced at the same rate as code 84155.

New code 85055 is priced at the same rate as code 86361.

New code 87269 is priced at the same rate as code 87272.

New code 87329 is priced at the same rate as code 87328.

New code 87660 is priced at the same rate as code 87470.

New code 89225 is priced at the same rate as deleted code 89355.

New code 89235 is priced at the same rate as deleted code 89365.

New code G0306 is priced at the same rate as code 85025.

New code G0307 is priced at the same rate as code 85027.

New code G0328 is priced at the same rate as code 86318.

New code G0328QW is priced at the same rate as code 86318.

Q: We struggle with the right way to bill for all the variations in CBC testing. Can you help clarify the rules in this area?

A: One of the highest volume tests – the complete blood count (CBC) — may also be the source of most billing errors. Where does the confusion come from? Let’s take a closer look. The most common CPT codes reported in conjunction with CBC billing are as follows: 85025 — Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count 85027– Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) 85007 — Blood count; blood smear, microscopic examination with manual differential WBC count

A common source of CBC coding and billing errors actually starts with interpretation of the order itself. For example:


 Q laboratory receives an order for a CBC. They run a CBC with automated differential and bill CPT 85025. Will this pass the test of an audit?

The answer is no. Unless the order specifically states that a differential is requested — CBC w/auto diff, CBC w/diff, etc. — reporting CPT 85025 would be considered an error. The correct code to report in this scenario is CPT 85027. The frequency of improper billing resulting from the misuse of CPT 85025, as illustrated in this scenario, is estimated to be as high as 30 percent by Medicare’s Comprehensive Error Rate Testing (CERT).

Confusion around differential billing extends beyond orders. It is common practice for a laboratory to perform a reflexive test from an automated differential to a manual differential when some portion of the result is abnormal. However, Correct Coding Initiative (CCI) edits prohibit billing CPTs 85025 and 85007 on the same date of service, as the automated differential and manual differential are considered duplicative. So what is the correct way to report these services? There are two options; the laboratory must decide to bill for one or the other. Option No. 1 — The CBC with automated differential is reported under CPT 85025 and CMS reimburses a maximum of $10.69. In this scenario, the laboratory does not submit a bill for the manually reviewed portion of the test.

Option No. 2 — The laboratory reports both CPTs 85027 ($8.89) and 85007 ($4.73) to capture the CBC (w/o differential) and manual differential.