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:
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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:
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