How much does Medicare pay for CPT 85004?

Medicare allowed an average of $6.29 per service and paid $6.29 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $27.78, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 85004?

White blood cell count. It was billed 20,846 times to 10,524 Medicare beneficiaries by 92 providers in 2024.

Which specialty bills 85004 most?

Clinical Laboratory, with 14,176 services from 64 clinicians. Next are Hematology-Oncology, Internal Medicine, Family Practice.

CPT 85004

White blood cell count

$6.29Medicare-allowed amount per service, averaged across 20,846 services

Providers submitted

$27.78

Asking price, not received

Medicare allowed

$6.29

The fee schedule figure

Medicare paid

$6.29

Balance is patient coinsurance

Providers submitted an average of $27.78 for this code and Medicare allowed $6.29 — 4.4× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $6.29 (100%); the rest is the patient’s coinsurance and deductible.

Services: 20,846
Beneficiaries: 10,524
Providers billing it: 92
Total allowed: $131,121

What Medicare pays for CPT 85004

Across 20,846 services billed by 92 providers to 10,524 beneficiaries, Medicare allowed an average of $6.29 per service. That is 2.0 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 85004

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	14,176	6,797	$6.29	64
Hematology-Oncology	1,873	353	$6.32	2
Internal Medicine	1,803	1,185	$6.34	3
Family Practice	1,559	1,186	$6.23	11
Rheumatology	548	183	$6.34	1
Nurse Practitioner	524	477	$6.29	6
Emergency Medicine	196	184	$6.29	1
Allergy/ Immunology	64	63	$6.34	1
Physician Assistant	54	47	$6.15	2
Pulmonary Disease	49	49	$6.34	1

85004 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Mississippi	3,445	$6.29	$6.34	16
Massachusetts	2,468	$6.34	$6.34	5
Florida	2,076	$6.33	$6.34	5
Arizona	1,461	$6.11	$6.34	2
New Jersey	1,215	$6.33	$6.34	6
Colorado	1,150	$6.34	$6.34	2
South Dakota	1,130	$6.32	$6.34	8
New York	1,090	$6.28	$6.34	4
Texas	1,069	$6.34	$6.34	4
Illinois	806	$6.34	$6.34	3
Pennsylvania	759	$6.34	$6.34	4
California	689	$6.33	$6.34	5
Minnesota	527	$6.34	$6.34	2
Ohio	502	$6.29	$6.34	3
North Carolina	372	$6.31	$6.34	2
Nevada	354	$6.34	$6.34	3
Wisconsin	323	$5.58	$6.34	1
Kansas	291	$6.34	$6.34	2
Iowa	196	$6.34	$6.34	1
Missouri	178	$6.34	$6.34	2
Puerto Rico	163	$6.25	$6.34	1
Alabama	117	$6.26	$6.34	1
Georgia	106	$6.34	$6.34	1
Arkansas	82	$6.34	$6.34	1
Maryland	77	$6.34	$6.34	2
Tennessee	64	$6.34	$6.34	1
Oklahoma	51	$6.34	$6.34	1
Washington	45	$6.34	$6.34	2
Louisiana	23	$6.34	$6.34	1
Virginia	17	$6.34	$6.34	1

Related codes

85025Complete blood cell count (red cells$7.59
85027Complete blood cell count (red cells$6.33
85045Red blood count$3.90
85018Blood count, hemoglobin$2.31
85014Red blood cell concentration measurement$2.31
85007Microscopic examination for white blood cells$3.71
85060Blood smear interpretation by physician$23.02
85097Bone marrow, smear interpretation$51.39
85046Red blood count automated$5.44
85044Red blood count$4.21
85055Reticulated (young) platelet measurement$34.89
85048Automated white blood cell count$2.47

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.