Automated complete blood count including hemoglobin, hematocrit, platelets, red cell indices, and an automated white cell differential.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 4 cited references ↓
- Clinical reason: suspected infection, anemia, blood loss, or anticoagulation
- Diagnosis linked to that reason
- Order specifying CBC with differential
- Lab report showing automated differential
- Timing of repeat draws when billed more than once a day
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 4 cited references ↓
85025 is the CBC with automated differential. It is the most common lab an orthopedic practice touches: pre-op hemoglobin before a joint replacement, a white count during an infection workup, platelets before a procedure on a patient taking blood thinners, and the post-op hemoglobin check after a big case.
The code already includes the CBC without differential (85027) and the automated differential. Do not bill 85027 or a separate differential code with it for the same draw. If the lab adds a manual smear review, check the lab's billing, since that may be a separate service.
Medicare covers blood counts under a national coverage determination with a long covered diagnosis list, but routine pre-op screening is still not covered. Link the reason: anemia, infection, anticoagulant therapy, or blood loss. Some CBC analyzers are CLIA-waived. If your office uses one, add QW on Medicare claims.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0 |
| Malpractice RVU | 0 |
| Total RVU | 0 |
| Medicare national rate | $0.00 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $0.00 |
Common denial reasons
The recurring reasons claims for CPT 85025 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billed with 85027 or a separate differential code
- Routine pre-op screening diagnosis only
- Missing QW on a waived office analyzer
- Same-day repeat without modifier 91
- Diagnosis not on the blood counts NCD list
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01Can I bill 85025 and 85027 together?
02Does Medicare pay for a CBC before knee replacement?
03When do I use modifier 91 on a CBC?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/medicare/payment/fee-schedules/clinical-laboratory-fee-schedule-clfs
- 03cms.govhttps://www.cms.gov/medicare/quality/clinical-laboratory-improvement-amendments
- 04cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits
Mira Scribe
Mira Scribe captures why the count was ordered, like wound drainage or a drop in hemoglobin, so the CBC has a diagnosis that matches.
See how Mira captures CPT 85025 documentation