CPT code 85025: Complete CBC, automated differential2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reports a complete blood count with an automated white blood cell differential, commonly ordered to assess blood-cell levels and investigate or monitor illness.
Medicare pays $7.77 for 85025 under the 2026 Clinical Laboratory Fee Schedule: one national amount, the same in every state and setting.
Medicare lab fee · CLFS 2026 Q4
National CLFS amount
$7.77
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2020
- Unchanged
- QW · CLIA-waived test
- $7.77
Medicare pays the lesser of the lab’s charge and this amount. Patients usually owe no Part B deductible or coinsurance for covered clinical lab tests.
On this page 8 sections
What 85025 covers
This test counts red blood cells, white blood cells, and platelets, measures hemoglobin and hematocrit, and adds an automated breakdown of white blood cell types. It is commonly ordered to evaluate anemia, infection, inflammation, and other conditions affecting blood-cell levels, and to monitor changes during care. Clinical laboratories perform and report it from a blood specimen.
Report 85025 for a complete count that includes an automated white blood cell differential; the differential is part of the service. For the CLIA-waived version, modifier QW identifies testing performed by a site holding a CLIA certificate of waiver. Medicare pays 85025 under the CLFS at one national amount, without locality or office-versus-facility adjustment; it is excluded from the physician fee schedule. The 2026 national CLFS amount is $7.77, unchanged from 2020 through 2025.
This summary was written with AI assistance from CMS Clinical Laboratory Fee Schedule data. Amounts on this page come directly from CMS files.
How Medicare pays 85025
Clinical lab tests aren’t priced like physician services. They’re paid from their own fee schedule, with its own rules. See the whole lab fee schedule.
One national amount
CMS sets a single Clinical Laboratory Fee Schedule amount for 85025. There’s no geographic (GPCI) adjustment, so it pays the same in every state and payment locality.
No office or facility rate
Lab tests aren’t built from relative value units, so there’s no office and facility split: the place of service doesn’t change the CLFS amount.
Updated every quarter
CMS republishes the CLFS each quarter. New tests, often proprietary laboratory analyses (PLA codes), join during the year; existing amounts are updated each January.
Excluded from the physician fee schedule
The physician fee schedule lists 85025 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 85025 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $7.77.
85025 on the lab fee schedule since 2020
85025 · CLFS 2026 Q4 (current)
$7.77
Unchanged since Jan 1, 2020
27 quarterly CLFS releases on file, first CLFS 2020 Q1. A code missing from a quarter wasn’t on that release.
85025 compared with similar tests
- 85027Complete CBCWithout automated differential$6.47
- Choose 85025 when the complete blood count includes an automated differential; 85027 describes the complete count without that differential.
- 85004WBC differentialAutomated count$6.47
- 85004 reports an automated white blood cell differential alone. It does not include the complete blood count reported with 85025.
- 85007Manual differentialMicroscopic white cell count$3.80
- 85007 describes a blood smear with a manual white blood cell differential; 85025 covers a complete blood count with an automated differential.
85025 billing questions
How does 85025 differ from 85027?
85025 includes an automated white blood cell differential in addition to the complete blood count. Use 85027 when the complete count is performed without that differential.
Can 85004 be reported instead of 85025?
85004 describes an automated white blood cell differential alone. It does not represent the complete blood count included in 85025.
When is modifier QW appropriate?
Use QW for the CLIA-waived version when the testing site holds a CLIA certificate of waiver.
How does Medicare pay for 85025?
Medicare pays the test under the CLFS at one national amount, with no locality or office-versus-facility adjustment.
Is the automated differential billed separately?
The automated differential is included in 85025. Code 85004 describes an automated differential performed without the complete CBC.
Where this amount comes from
FeeBase reads lab amounts directly from the CMS Clinical Laboratory Fee Schedule file for the quarter: one row per code, with its payment indicator and national amount. Contractor-priced tests are labeled, never given a made-up amount. Amounts are Medicare payment limits, not a patient’s bill or a commercial rate.
CMS CLFS 2026 Q4 · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file line behind this amount
Fee sheets
Put 85025 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet