How much does Medicare pay for CPT 85007?

Medicare allowed an average of $3.71 per service and paid $3.71 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $19.25, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 85007?

Microscopic examination for white blood cells with manual cell count. It was billed 183,696 times to 90,612 Medicare beneficiaries by 1,031 providers in 2024.

Does 85007 pay differently in an office than a hospital?

Yes. The allowed amount averaged $3.71 in an office setting and $3.72 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 85007 most?

Clinical Laboratory, with 86,145 services from 168 clinicians. Next are Hematology-Oncology, Medical Oncology, Internal Medicine.

CPT 85007

Microscopic examination for white blood cells with manual cell count

$3.71Medicare-allowed amount per service, averaged across 183,696 services

Providers submitted

$19.25

Asking price, not received

Medicare allowed

$3.71

The fee schedule figure

Medicare paid

$3.71

Balance is patient coinsurance

Providers submitted an average of $19.25 for this code and Medicare allowed $3.71 — 5.2× 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 $3.71 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $3.71
Hospital / facility: $3.72

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 183,665 services were billed in an office setting and 31 in a facility.

Services: 183,696
Beneficiaries: 90,612
Providers billing it: 1,031
Total allowed: $681,512

What Medicare pays for CPT 85007

Across 183,696 services billed by 1,031 providers to 90,612 beneficiaries, Medicare allowed an average of $3.71 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 85007

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	86,145	50,534	$3.72	168
Hematology-Oncology	50,891	15,866	$3.71	314
Medical Oncology	15,573	5,217	$3.71	143
Internal Medicine	9,233	6,048	$3.72	95
Pathology	6,390	3,629	$3.71	22
Nurse Practitioner	5,050	2,534	$3.72	103
Physician Assistant	3,279	1,741	$3.71	45
Family Practice	2,765	2,139	$3.72	85
Rheumatology	865	510	$3.71	11
Cardiology	799	662	$3.72	5
Nephrology	710	354	$3.69	4
Gastroenterology	355	241	$3.71	2
Endocrinology	305	257	$3.70	6
Hematology	250	102	$3.71	2
General Practice	200	163	$3.69	3

85007 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
Texas	36,567	$3.71	$3.72	411
Kansas	22,542	$3.71	$3.72	30
California	15,054	$3.72	$3.72	53
New York	14,020	$3.71	$3.72	99
New Jersey	13,635	$3.72	$3.72	9
Illinois	13,557	$3.71	$3.72	45
Missouri	9,068	$3.72	$3.72	4
Tennessee	8,188	$3.71	$3.72	8
Arizona	5,255	$3.72	$3.72	32
Pennsylvania	5,138	$3.71	$3.72	25
Nebraska	4,160	$3.72	$3.72	27
Oklahoma	3,763	$3.71	$3.72	3
Florida	3,659	$3.71	$3.72	16
Massachusetts	2,862	$3.72	$3.72	18
Minnesota	2,635	$3.72	$3.74	21
Virginia	2,339	$3.71	$3.72	25
North Carolina	2,170	$3.72	$3.72	12
Ohio	2,019	$3.71	$3.72	16
Maryland	1,843	$3.71	$3.72	11
Wisconsin	1,674	$3.71	$3.72	12
Washington	1,636	$3.71	$3.72	7
Mississippi	1,346	$3.68	$3.72	12
South Dakota	1,232	$3.71	$3.72	13
Alabama	1,045	$3.70	$3.72	7
Louisiana	913	$3.71	$3.72	5
North Dakota	845	$3.72	$3.72	9
Georgia	811	$3.71	$3.72	15
Michigan	689	$3.71	$3.72	4
Colorado	656	$3.69	$3.72	17
Maine	552	$3.72	$3.72	10
Indiana	514	$3.69	$3.72	9
Kentucky	428	$3.68	$3.72	1
South Carolina	374	$3.70	$3.72	5
Utah	349	$3.72	$3.72	3
Connecticut	321	$3.72	$3.72	4
Oregon	319	$3.72	$3.72	4
Iowa	313	$3.72	$3.72	7
New Mexico	298	$3.71	$3.72	6
Puerto Rico	214	$3.72	$3.72	6
Hawaii	207	$3.39	$3.72	2
Montana	177	$3.72	$3.72	3
New Hampshire	126	$3.72	$3.72	1
Idaho	126	$3.72	$3.72	1
Nevada	28	$3.72	$3.72	1
Arkansas	18	$3.72	$3.72	1
Rhode Island	11	$3.72	$3.72	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
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
85049Platelet count$4.37

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.