How much does Medicare pay for CPT 85025?

Medicare allowed an average of $7.59 per service and paid $7.59 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $37.11, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 85025?

Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count. It was billed 26,108,717 times to 14,440,780 Medicare beneficiaries by 32,034 providers in 2024.

Does 85025 pay differently in an office than a hospital?

Yes. The allowed amount averaged $7.59 in an office setting and $7.61 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 85025 most?

Clinical Laboratory, with 17,713,465 services from 1,266 clinicians. Next are Hematology-Oncology, Family Practice, Internal Medicine.

CPT 85025

Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count

$7.59Medicare-allowed amount per service, averaged across 26,108,717 services

Providers submitted

$37.11

Asking price, not received

Medicare allowed

$7.59

The fee schedule figure

Medicare paid

$7.59

Balance is patient coinsurance

Providers submitted an average of $37.11 for this code and Medicare allowed $7.59 — 4.9× 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 $7.59 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $7.59
Hospital / facility: $7.61

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 26,098,244 services were billed in an office setting and 10,473 in a facility.

Services: 26,108,717
Beneficiaries: 14,440,780
Providers billing it: 32,034
Total allowed: $198,165,162

What Medicare pays for CPT 85025

Across 26,108,717 services billed by 32,034 providers to 14,440,780 beneficiaries, Medicare allowed an average of $7.59 per service. That is 1.8 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 85025

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	17,713,465	10,146,111	$7.60	1,266
Hematology-Oncology	2,485,512	745,634	$7.58	2,247
Family Practice	1,548,997	1,054,069	$7.58	8,009
Internal Medicine	1,460,025	915,517	$7.58	5,013
Medical Oncology	642,664	193,440	$7.58	677
Nurse Practitioner	631,590	432,757	$7.57	6,737
Pathology	431,573	248,480	$7.58	132
Rheumatology	319,206	153,791	$7.55	782
Physician Assistant	255,715	185,101	$7.57	3,331
Nephrology	99,901	57,851	$7.57	407
Endocrinology	89,623	54,789	$7.59	347
Hematology	84,435	21,929	$7.58	65
Cardiology	77,812	52,983	$7.60	432
Gastroenterology	44,787	30,199	$7.52	326
General Practice	33,325	22,002	$7.57	143

85025 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
Florida	2,967,713	$7.60	$7.61	1,885
California	2,699,786	$7.60	$7.61	1,137
New Jersey	2,579,294	$7.60	$7.61	698
Texas	2,528,909	$7.59	$7.61	2,964
North Carolina	1,709,397	$7.60	$7.61	1,881
New York	1,244,879	$7.60	$7.61	2,060
Arizona	955,940	$7.60	$7.61	563
Ohio	916,192	$7.59	$7.61	573
Tennessee	852,577	$7.58	$7.61	1,927
Alabama	790,918	$7.59	$7.61	990
Illinois	726,734	$7.60	$7.61	850
Georgia	698,233	$7.59	$7.61	1,019
Virginia	635,189	$7.59	$7.61	1,130
Maryland	563,800	$7.59	$7.61	667
Kansas	520,396	$7.60	$7.61	362
Pennsylvania	462,572	$7.60	$7.61	412
Massachusetts	459,795	$7.61	$7.61	718
Washington	403,322	$7.59	$7.61	652
Oklahoma	346,720	$7.59	$7.61	354
South Carolina	317,153	$7.57	$7.61	800
Arkansas	273,852	$7.57	$7.61	704
Wisconsin	268,753	$7.55	$7.61	834
Nevada	254,413	$7.59	$7.61	159
Michigan	242,460	$7.58	$7.61	483
Colorado	232,871	$7.59	$7.61	204
Mississippi	232,198	$7.55	$7.61	834
Louisiana	212,261	$7.59	$7.61	437
Missouri	197,412	$7.60	$7.61	505
Minnesota	197,125	$7.58	$7.61	1,519
Indiana	193,282	$7.59	$7.61	238
Iowa	184,114	$7.58	$7.61	757
Oregon	180,870	$7.58	$7.61	452
Kentucky	161,213	$7.59	$7.61	314
Nebraska	134,211	$7.59	$7.61	396
Hawaii	133,827	$7.58	$7.61	16
Utah	99,299	$7.58	$7.61	494
New Mexico	83,822	$7.58	$7.61	84
Connecticut	63,639	$7.58	$7.61	249
South Dakota	53,904	$7.59	$7.61	250
Puerto Rico	47,221	$7.57	$7.61	356
North Dakota	45,721	$7.60	$7.61	135
Maine	37,921	$7.58	$7.61	200
Rhode Island	35,310	$7.60	$7.61	13
Idaho	33,450	$7.56	$7.61	142
Alaska	23,412	$7.56	$7.61	157
West Virginia	22,136	$7.57	$7.61	92
Montana	21,395	$7.59	$7.61	61
Wyoming	19,034	$7.59	$7.61	101
Delaware	10,462	$7.60	$7.61	8
New Hampshire	10,004	$7.59	$7.61	108
U.S. Virgin Islands	8,047	$7.59	$7.61	9
District of Columbia	6,680	$7.60	$7.61	23
Vermont	6,643	$7.58	$7.61	43
XX	1,536	$7.60	$7.61	2
Guam	569	$7.54	$7.61	8
AE	86	$7.54	$7.61	2

Related codes

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
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.