Summary & Overview
CPT 85027: Complete Blood Count with Hemoglobin and Hematocrit
Headline: CPT code 85027: Complete Blood Count with Hemoglobin and Hematocrit — core laboratory test with broad clinical use
Lead: CPT code 85027 represents the standard complete blood count that quantifies red and white blood cells and platelets and measures hemoglobin and calculates hematocrit in whole blood. It is a foundational laboratory test used across inpatient and outpatient settings for diagnosis, monitoring, and pre-procedural evaluation.
What the code represents and why it matters: CPT code 85027 denotes an automated CBC with hemoglobin and hematocrit measurements. As one of the most frequently ordered lab tests, it supports diagnoses such as anemia, infection, bleeding disorders, and metabolic conditions. Its ubiquity makes it essential to laboratory workflows, billing operations, and clinical decision-making nationally.
Key payers covered: Analysis and benchmarks include major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Overview of reader takeaways: Readers will gain a concise clinical and billing orientation to CPT code 85027, understand its typical sites of service and clinical contexts, and find links to related laboratory codes for differential or automated counts. The publication summarizes payer coverage landscape and coding relationships to support coding accuracy and billing alignment. Data not available in the input for certain payer-specific rates or utilization metrics is noted where applicable.
Billing Code Overview
CPT code 85027 describes a complete blood count (CBC) with hemoglobin and hematocrit determination performed on a whole blood sample. The procedure includes automated counts of red blood cells, white blood cells, and platelets (thrombocytes), measurement of hemoglobin typically by spectrophotometry, and calculation of hematocrit (packed red cell volume).
Service Type: Laboratory diagnostic testing — complete blood count with Hgb/Hct
Typical Site of Service: Clinical laboratory or hospital laboratory; outpatient phlebotomy collection sites
Clinical & Coding Specifications
Clinical Context
A 43-year-old patient presents to an outpatient family medicine clinic with several weeks of progressive fatigue, pallor, and exertional dyspnea. The clinician documents a suspected iron deficiency anemia and orders diagnostic laboratory testing. A venous whole blood specimen is collected and sent to the clinical laboratory for a complete blood count that includes red blood cell indices, white blood cell count, platelet (thrombocyte) count, hemoglobin measurement (typically by spectrophotometry), and hematocrit calculation. The laboratory technologist performs automated analysis using a hematology analyzer, validates results, and reports values to the ordering provider. The CBC result is used to confirm anemia, quantify severity, monitor response to iron therapy, and guide further workup (iron studies, reticulocyte count) or urgent management for a precipitous drop in hematocrit. Typical encounter settings include outpatient clinic visits, urgent care, emergency department visits, preoperative assessments, and inpatient hospital laboratories when baseline or monitoring blood counts are required.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing for the physician interpretation component if separated from technical lab services |
90 |