Summary & Overview
CPT 85025: Complete Blood Count with Automated Differential
CPT code 85025 is a widely utilized billing code for a complete blood count (CBC) with automated differential, hemogram, and platelet count. This procedure is essential in clinical practice, serving as a fundamental diagnostic tool for evaluating a patient's hematologic status and identifying conditions such as anemia, infection, and other blood disorders. The code is most commonly billed in office settings and is recognized by major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
This publication provides a comprehensive overview of 85025, covering clinical context, payer coverage, and relevant policy updates. Readers will gain insight into typical use cases, associated diagnoses, and bundling guidance with related codes such as 80050. The summary also addresses common billing modifiers and taxonomies relevant to laboratory and physician services. Benchmarks and trends in utilization are discussed, offering a clear understanding of how this code fits into broader hematology and laboratory billing practices. The information is designed to support stakeholders in navigating payer requirements and understanding the clinical significance of the CBC with differential.
CPT Code Overview
CPT code 85025 represents a comprehensive blood count procedure, including a hemogram, platelet count, and an automated complete differential white blood cell (WBC) count. This test is a cornerstone of hematology and coagulation procedures, providing critical information about a patient's blood composition and overall health status. The typical site of service for this procedure is the office setting, designated as Place of Service 11. The automated nature of the test allows for efficient and accurate assessment, supporting clinical decision-making across a wide range of medical specialties.
Clinical & Coding Specifications
Clinical Context
A patient presents to a family medicine or internal medicine office with symptoms such as fatigue, malaise, or general weakness. The provider orders a complete blood count (CBC) with automated hemogram, platelet count, and automated differential white blood cell count, represented by CPT code 85025. The test is performed in a clinical medical laboratory, and results are used to evaluate for conditions like iron deficiency anemia or other causes of anemia and general symptoms.
Coding Specifications
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Modifiers:
- Modifier
26: Used to indicate the professional component of the service, typically when the physician interprets the results but does not perform the technical aspect. - Modifier
TC: Used to indicate the technical component, typically when the laboratory performs the test but does not interpret the results.
- Modifier
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
291U00000X | Clinical Medical Laboratory |
207Q00000X | Family Medicine Physician |
207R00000X | Internal Medicine Physician |
Related Diagnoses
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D50.9: Iron deficiency anemia, unspecified- Relevant for patients with suspected or confirmed iron deficiency anemia, which is commonly evaluated with a CBC.
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R53.81: Other malaise- Used when patients present with general malaise, prompting a CBC to rule out underlying hematologic causes.
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R53.83: Other fatigue- Fatigue is a frequent symptom leading to CBC testing to assess for anemia or other blood disorders.
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D64.9: Anemia, unspecified- CBC is essential for evaluating and diagnosing unspecified anemia.
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R68.89: Other general symptoms and signs- Used for patients with non-specific symptoms where a CBC may help identify underlying conditions.
Related CPT Codes
80050: General health panel including CBC (implied inclusion; mentioned as bundling guidance with85025).
80050 includes a CBC as part of a broader panel. In clinical workflow, 80050 may be ordered when a comprehensive health assessment is needed, and it bundles the CBC (85025) with other tests. 85025 is commonly used alone for targeted hematologic evaluation, but when 80050 is ordered, 85025 should not be billed separately due to bundling rules.
National Reimbursement Benchmarks
National mean rates for CPT code 85025 show that BUCA (average commercial) payers reimburse at $8.98, while Medicare rates are not available in the input. Among individual commercial payers, Aetna and Cigna have the highest mean rates at $11.11 and $10.67, respectively, while UnitedHealth Group is lowest at $6.66.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Aetna and Cigna exhibit the widest spreads ($6.05 and $5.89), indicating greater variability in contracted rates. Blue Cross Blue Shield and BUCA have tighter ranges ($2.67 and $3.79), suggesting more consistent reimbursement levels. UnitedHealth Group has a moderate spread of $3.88.
The table and chart below present the full breakdown of national benchmarks for CPT code 85025 across major commercial payers.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.