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    v1.0.30
    OpenPayerBilling CodesHematology and Coagulation ProceduresCPT cpt-85018-hemoglobin-assay-whole-blood
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    CPT 85018: Hemoglobin Measurement in Whole Blood

    Commercial payers pay $17 on average nationally for this procedure.

    CPT code 85018 describes a laboratory procedure in which a lab analyst measures hemoglobin concentration in a whole blood sample; this is a clinical laboratory service typically performed in a hospital or outpatient laboratory setting to assess red blood cell oxygen-carrying capacity and aid evaluation of anemia or related symptoms.

    For related coverage guidance, see recent payer policy updates: Hematology - Adzynma, Tumor Treating Fields for Pancreatic Cancer, Axicabtagene ciloleucel (Yescarta®) coverage.

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    National Reimbursement Benchmarks

    For CPT 85018, BUCA’s average commercial rate sits at $17.10, representing a mid-market reference point across national commercial payers. Blue Cross Blue Shield displays a relatively narrow interquartile spread (P75 $17.00 minus P25 $9.90 = $7.10), and UnitedHealth Group also shows tight dispersion (P75 $2.80 minus P25 $1.40 = $1.40), indicating more consistent contracted rates. Cigna’s spread is modest (P75 $4.20 minus P25 $1.90 = $2.30), while Aetna exhibits the widest dispersion by far (P75 $7.10 minus P25 $2.00 = $5.10) when considering its very large maximum outlier.

    Blue Cross Blue Shield and UnitedHealth Group therefore represent the tightest interquartile consistency among listed payers, with ranges of $7.10 and $1.40 respectively, while Aetna shows the broadest middle-range variability at $5.10. Cigna and BUCA fall between those extremes, with Cigna’s IQR at $2.30 and BUCA’s interquartile range at $5.30 (P75 $11.70 minus P25 $6.40 = $5.30), reflecting moderate dispersion around BUCA’s $17.10 average.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 42-year-old female presents to a primary care clinic with progressive fatigue, pallor, and intermittent lightheadedness. The clinician documents suspected iron deficiency anemia and orders laboratory evaluation including a quantitative hemoglobin measurement. A phlebotomy technician collects a whole blood sample during the office visit; the sample is sent to the clinical laboratory. A laboratory analyst performs 85018 to determine the hemoglobin concentration in the whole blood specimen. Results are reported to the ordering Family Medicine physician who may correlate hemoglobin with additional tests (CBC, iron studies) and the patient’s symptoms. Typical workflow: order placed by outpatient clinician → specimen collection in clinic or outpatient draw station → transport to clinical laboratory (hospital or independent lab) → performance of 85018 and reporting of result into the electronic health record. Typical sites of service: outpatient clinic, physician office laboratory, ambulatory phlebotomy center, and hospital laboratory. Common clinical reasons for this test include evaluation of anemia (e.g., D50.9, D64.9), assessment of unexplained fatigue (R53.83), general symptom evaluation (R68.89), and screening encounters for blood disorders (Z13.0).

    Related CPT Codes

    CPT Code

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    90Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
    91Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
    99Modifier 99 is a placeholder modifier used when more modifiers apply to a single procedure than the claim form or electronic field allows. The AMA classifies it under Provider Services and Ambulatory…- Use CPT modifier -99 when more modifiers apply to a single procedure line than the claim form or payer field allows (CMS/Noridian: when more than four modifiers are needed); append modifier 99 on…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    291U00000X
    207Q00000X
    207R00000X
    347E00000X
    207VF0040X
    207VM0101X
    103TS0200X
    207QB0002X

    Related ICD-10-CM Codes

    31 rows

    ICD-10-CM CodeDescription
    C34.90Malignant neoplasm of unspecified part of unspecified bronchus or lung
    C50.912Malignant neoplasm of unspecified site of left female breast
    C61Malignant neoplasm of prostate
    D50.0Iron deficiency anemia secondary to blood loss (chronic)
    D50.9Iron deficiency anemia, unspecified
    D51.0Vitamin B12 deficiency anemia due to intrinsic factor deficiency
    D52.9Folate deficiency anemia, unspecified
    D53.9Nutritional anemia, unspecified
    D56.9Thalassemia, unspecified
    D57.1Sickle-cell disease without crisis

    Showing 1–10 of 31

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    Hematology - AdzynmaCigna2026-10-15
    Tumor Treating Fields for Pancreatic Cancerselect_health2026-10-01
    Axicabtagene ciloleucel (Yescarta®) coverageBaylor Scott & White Health Plan2026-10-01
    Electric Tumor Treatment Field Therapy (for Kentucky Only)UnitedHealthcare2026-10-01
    Electric Tumor Treatment Field Therapy (for Kansas Only)UnitedHealthcare2026-10-01
    Electric Tumor Treatment Field Therapy (for Idaho Only)UnitedHealthcare2026-10-01
    Brexucabtagene autoleucel (Tecartus) CoverageBaylor Scott & White Health Plan2026-10-01
    Electric Tumor Treatment Field Therapy (for Pennsylvania Only)UnitedHealthcare2026-10-01
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Factor VIII ProductsCigna2026-09-15

    Related Codes

    CPT-85002-BLEEDING-TIME-TEST-LABORATORY

    CPT 85002: Bleeding Time Test, Technical Component

    CPT-85004-AUTOMATED-DIFFERENTIAL-WHITE-BLOOD-CELL-COUNT

    CPT 85004: Automated White Blood Cell Differential

    CPT-85007-MANUAL-DIFFERENTIAL-WHITE-BLOOD-CELL-COUNT

    CPT 85007: Manual Differential White Blood Cell Count

    CPT-85008-BLOOD-SMEAR-MORPHOLOGIC-REVIEW-NO-DIFFERENTIAL

    CPT 85008: Microscopic Blood Smear Examination, No Differential

    CPT-85009-MANUAL-WBC-COUNT-BUFFY-COAT

    CPT 85009: Manual White Blood Cell Count Using Buffy Coat

    CPT-85013-MICROHEMATOCRIT-TEST-LABORATORY-DIAGNOSTIC

    CPT 85013: Microhematocrit Test by Tube Centrifugation

    CPT-85014-HEMATOCRIT-VOLUME-PERCENT-RED-BLOOD-CELLS

    CPT 85014: Hematocrit (Volume Percent of Red Blood Cells)

    CPT-85025-COMPLETE-BLOOD-COUNT-CBC

    CPT 85025: Complete Blood Count (CBC)

    CPT-85027-COMPLETE-BLOOD-COUNT-HGB-HCT

    CPT 85027: Complete Blood Count with Hemoglobin and Hematocrit

    CPT-85032-MANUAL-DIFFERENTIAL-BLOOD-SMEAR-COUNT

    CPT 85032: Manual Differential/Visual Cell Count

    Showing 1–10 of 99

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Description
    Relationship to This Procedure
    85025Complete (CBC), automated (HgB, Hct, RBC, WBC and platelet count) and automated differential WBC countOften ordered alongside or instead of 85018 when a full CBC including hemoglobin and differential is required for anemia evaluation.
    85027Complete (CBC), automated (HgB, Hct, RBC, WBC and platelet count)Alternative to 85025 when a differential WBC count is not needed; includes hemoglobin measurement as part of the panel.
    85032Manual cell count eachMay be performed when automated counts are unreliable; complements hemoglobin testing in evaluation of abnormal results.
    85041Automated RBC countProvides red blood cell count data that complements hemoglobin measurement for anemia workup.
    85044Manual reticulocyte countUsed to assess marrow response in anemia and often follows abnormal hemoglobin findings.
    85045Automated reticulocyte countAlternative to manual reticulocyte count to evaluate bone marrow reticulocyte production after abnormal hemoglobin.
    85046Reticyte/Hgb concentrateRelated specialty assay sometimes used in research or specialized hematology workflows alongside hemoglobin results.
    85048Automated leukocyte countProvides white blood cell information that is part of broader hematologic assessment accompanying hemoglobin measurement.
    85049Automated platelet countPlatelet data are often reported with hemoglobin in CBC panels to evaluate bleeding risk or marrow function.
    85055Reticulated platelet assaySpecialized platelet function/production test that may be ordered when hemoglobin abnormalities coincide with platelet concerns.