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    v1.0.31
    OpenPayerBilling CodesHematology and Coagulation ProceduresCPT cpt-85027-complete-blood-count-hgb-hct
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    CPT 85027: Complete Blood Count with Hemoglobin and Hematocrit

    Commercial payers pay $21 on average nationally for this procedure.

    CPT code 85027 describes a complete blood count (CBC) performed by a laboratory analyst that measures red and white blood cells, platelets (thrombocytes), hemoglobin (typically by spectrophotometry), and hematocrit (packed red cell volume calculated) on a whole blood sample; service type: laboratory diagnostic test; typical site of service: clinical laboratory or hospital outpatient laboratory.

    For related coverage guidance, see recent payer policy updates: Bendamustine Products Coverage Criteria, T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and Romidepsin, Brentuximab Vedotin (Adcetris®) Coverage Criteria.

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    National Reimbursement Benchmarks

    National commercial averages center around BUCA’s mean of $21.30 for CPT 85027, with Blue Cross Blue Shield and Aetna showing the highest top-end variability. Blue Cross Blue Shield has a broad spread between its 75th and 25th percentiles of $14.60 ($36.80 − $21.20), indicating wider commercial rate dispersion, while Aetna’s spread is $6.00 ($10.80 − $5.00). Cigna and UnitedHealth Group display tighter interquartile ranges of $4.20 ($9.20 − $5.00) and $3.70 ($6.50 − $2.80), respectively, suggesting more concentrated pricing around their medians.

    Looking at central tendencies, Blue Cross Blue Shield’s mean of $31.50 sits well above BUCA’s average, while Aetna and Cigna have means closer to the BUCA benchmark at $10.20 and $7.50. UnitedHealth Group’s mean of $5.70 is the lowest among named payers. The differing interquartile ranges highlight that Blue Cross Blue Shield and BUCA exhibit wider commercial variability, whereas UnitedHealth Group and Cigna are comparatively tight.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    85025Complete CBC with automated differential WBC countExtends 85027 by adding an automated differential; performed when leukocyte differential is clinically indicated

    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…
    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…
    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…
    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…
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    291U00000X
    207Q00000X
    207R00000X
    2080P0207X
    2080H0002X
    2080P0006X
    364SE1400X
    2083A0100X

    Related ICD-10-CM Codes

    5 rows

    ICD-10-CM CodeDescription
    R68.89Other general symptoms and signs
    R71.0Precipitous drop in hematocrit
    D50.9Iron deficiency anemia, unspecified
    D64.9Anemia, unspecified
    R53.83Other fatigue

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    Bendamustine Products Coverage Criteriablue cross blue shield - tennessee2027-01-30
    T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and RomidepsinMass General Brigham Health Plan2027-01-04
    Brentuximab Vedotin (Adcetris®) Coverage Criteriablue cross blue shield - tennessee2026-12-31
    Pemetrexed Coverageblue cross blue shield - tennessee2026-12-31
    Tumor Treatment Fields - Medical PolicyHealth-New-England2026-12-01
    Extracorporeal PhotopheresisCigna2026-11-15
    VonvendiCigna2026-11-15
    Hematology - AphexdaCigna2026-11-15
    Extracorporeal PhotopheresisCigna2026-11-15
    Yartemlea (narsoplimab-wuug) Coverage for TA-TMANeighborhood Health Plan of Rhode Island2026-11-01

    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-85018-HEMOGLOBIN-ASSAY-WHOLE-BLOOD

    CPT 85018: Hemoglobin Measurement in Whole Blood

    CPT-85025-COMPLETE-BLOOD-COUNT-CBC

    CPT 85025: Complete Blood Count (CBC)

    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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    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    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.

    85004
    Blood count automated differential white blood cell count
    Focuses on the automated differential component; may be billed in conjunction when differential is specifically required