Summary & Overview
CPT 85027: Complete CBC, automated (Hgb, Hct, RBC, WBC, platelet)
Headline: CPT 85027 — Automated Complete Blood Count (CBC) for Core Hematology Testing
Lead: CPT 85027 identifies the automated complete blood count (CBC) that reports hemoglobin, hematocrit, RBC, WBC, and platelet counts. The CBC is one of the most frequently ordered laboratory tests nationwide and serves as a frontline diagnostic and monitoring tool across outpatient, inpatient, and ambulatory laboratory settings.
What this code represents and why it matters: As an automated CBC, CPT 85027 captures essential quantitative blood cell measures used in diagnosing anemia, infection, and many systemic disorders. Its broad clinical utility makes it a high-volume pathology/laboratory service with implications for laboratory workflows, billing practices, and clinical decision-making.
Key payers covered: Major commercial payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
Overview of reader takeaways: Readers will gain a concise description of the service definition and clinical context for CPT 85027; visibility into payer coverage considerations and common billing modifiers; comparisons and distinctions versus related CBC codes such as CPT 85025 and CPT 85004; and typical sites of service where the test is performed. Where input data is missing, the document will note "Data not available in the input."
CPT Code Overview
CPT 85027 is a complete complete blood count (CBC), automated, reporting hemoglobin (Hgb), hematocrit (Hct), red blood cell count (RBC), white blood cell count (WBC), and platelet count. This test provides core hematologic indices used to screen for and monitor anemia, infection, and other systemic conditions.
Service Type: Pathology and Laboratory Procedures – Hematology
Typical Site of Service: Laboratory (POS 81 or POS 19)
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient clinic or laboratory with symptoms such as fatigue, pallor, or a recent unexplained drop in hematocrit. A clinician (family medicine or internal medicine) orders a complete blood count to evaluate hemoglobin, hematocrit, red blood cell indices, white blood cell count, and platelet count. The phlebotomy is performed in a laboratory setting (POS 81 or POS 19) and the specimen is processed on an automated hematology analyzer. Results are reviewed by the ordering clinician; if performed in a reference lab, results are transmitted back to the ordering provider for interpretation. The workflow includes specimen collection, transport to the laboratory, automated analysis, result verification, and reporting back to the ordering clinician.
Coding Specifications
Modifier 26 and Modifier 90 are commonly used with this service.
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Modifier
26: Used when reporting the professional component only (interpretation or professional review) separate from the technical component of laboratory testing. -
Modifier
90: Used to indicate the test was performed by a reference (outside) laboratory; used when the performing laboratory is not the billing laboratory. -
TC (technical component): Data not available in the input.
Associated provider taxonomies:
| Taxonomy Code | Specialty |
|---|---|
291U00000X | Clinical Medical Laboratory |
207Q00000X | Family Medicine Physician |
207R00000X | Internal Medicine Physician |
Related Diagnoses
| ICD-10 Code | Description | Clinical relevance to 85027 |
|---|---|---|
D50.9 | Iron deficiency anemia, unspecified | CBC assesses hemoglobin, hematocrit, RBC indices to identify anemia and guide iron deficiency evaluation. |
R53.83 | Other fatigue | Fatigue is a common symptom prompting a CBC to evaluate for anemia or other hematologic causes. |
R68.89 | Other general symptoms and signs | Nonspecific symptoms that may lead a clinician to order a CBC as part of baseline evaluation. |
D64.9 | Anemia, unspecified | CBC provides objective measures (Hgb, Hct, RBC) to confirm and characterize anemia. |
R71.0 | Precipitate drop in hematocrit | A sudden decrease in hematocrit is directly evaluated with CBC measurements to quantify the change. |
Related CPT Codes
| CPT Code | Description |
|---|---|
85025 | Complete CBC with automated differential WBC count |
85004 | Blood count automated differential white blood cell count |
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85025is an expanded CBC that includes an automated differential of the white blood cell count; it is used when differential information is required in addition to the basic CBC elements provided by85027. -
85004is focused on automated differential white blood cell count and may be ordered when differential details are the primary need; it may be used in conjunction with or as an alternative to85027depending on clinical need. -
85025and85004are commonly used as alternatives or supplements to85027in clinical workflows where a differential WBC is required in addition to the basic CBC.
National Reimbursement Benchmarks
National commercial mean rates cluster above Medicare-level rates: BUCA (the combined commercial benchmark) posts a mean of $7.35 while Medicare is represented as $0.00 in the input. Aetna and Cigna report the highest commercial means at $8.48 and $9.35 respectively, with UnitedHealth Group and Blue Cross Blue Shield lower at $5.65 and $6.61.
Rate dispersion (P75 minus P25) varies across payers. Cigna (P75 $9.00 vs P25 $4.75) and Aetna (P75 $8.75 vs P25 $4.09) show the widest spreads, indicating more variability in allowed amounts. UnitedHealth Group (P75 $6.00 vs P25 $3.00) and BCBS (P75 $7.00 vs P25 $5.00) are tighter by comparison. The table and chart below present the full breakdown.
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.