How much does Medicare pay for CPT 85027?

Medicare allowed an average of $6.33 per service and paid $6.33 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $31.99, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 85027?

Complete blood cell count (red cells, white blood cell, platelets), automated test. It was billed 3,287,573 times to 2,278,566 Medicare beneficiaries by 7,224 providers in 2024.

Does 85027 pay differently in an office than a hospital?

Yes. The allowed amount averaged $6.33 in an office setting and $6.34 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 85027 most?

Clinical Laboratory, with 2,535,305 services from 576 clinicians. Next are Family Practice, Internal Medicine, Nurse Practitioner.

CPT 85027

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

$6.33Medicare-allowed amount per service, averaged across 3,287,573 services

Providers submitted

$31.99

Asking price, not received

Medicare allowed

$6.33

The fee schedule figure

Medicare paid

$6.33

Balance is patient coinsurance

Providers submitted an average of $31.99 for this code and Medicare allowed $6.33 — 5.1× 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 $6.33 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $6.33
Hospital / facility: $6.34

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 3,286,068 services were billed in an office setting and 1,505 in a facility.

Services: 3,287,573
Beneficiaries: 2,278,566
Providers billing it: 7,224
Total allowed: $20,810,337

What Medicare pays for CPT 85027

Across 3,287,573 services billed by 7,224 providers to 2,278,566 beneficiaries, Medicare allowed an average of $6.33 per service. That is 1.4 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 85027

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	2,535,305	1,804,027	$6.33	576
Family Practice	182,215	143,306	$6.31	1,927
Internal Medicine	157,115	107,933	$6.32	1,197
Nurse Practitioner	101,628	50,734	$6.32	1,217
Hematology-Oncology	74,747	25,927	$6.31	413
Pathology	60,079	43,243	$6.32	92
Nephrology	51,103	18,911	$6.32	204
Physician Assistant	32,437	25,918	$6.30	647
Medical Oncology	20,337	6,956	$6.32	172
Rheumatology	18,163	9,540	$6.30	77
Endocrinology	9,892	6,636	$6.31	90
Interventional Cardiology	8,842	7,084	$6.31	66
Cardiology	8,181	6,720	$6.30	141
Urology	5,447	4,463	$6.30	103
Emergency Medicine	4,197	3,684	$6.31	46

85027 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
New Jersey	407,374	$6.34	$6.34	84
California	339,425	$6.34	$6.34	204
North Carolina	251,569	$6.33	$6.34	513
Florida	235,172	$6.34	$6.34	99
Texas	174,617	$6.33	$6.34	630
Arizona	165,296	$6.33	$6.34	171
Massachusetts	148,833	$6.34	$6.34	412
Ohio	139,622	$6.33	$6.34	81
Illinois	124,439	$6.33	$6.34	184
New York	109,484	$6.34	$6.34	263
Tennessee	108,582	$6.31	$6.34	393
Virginia	100,463	$6.33	$6.34	209
Kansas	90,253	$6.33	$6.34	78
Minnesota	80,865	$6.31	$6.34	1,103
Georgia	66,918	$6.32	$6.34	96
Washington	64,492	$6.32	$6.34	297
Pennsylvania	63,987	$6.33	$6.34	67
Alabama	61,627	$6.33	$6.34	56
Maryland	57,738	$6.33	$6.34	41
Wisconsin	56,468	$6.30	$6.34	437
South Carolina	56,199	$6.31	$6.34	261
Nebraska	29,391	$6.32	$6.34	151
Oregon	28,192	$6.32	$6.34	88
Nevada	25,486	$6.33	$6.34	8
Iowa	25,383	$6.31	$6.34	139
Oklahoma	24,059	$6.33	$6.34	29
Colorado	22,042	$6.33	$6.34	51
Missouri	20,538	$6.33	$6.34	80
Louisiana	20,478	$6.33	$6.34	87
Mississippi	20,198	$6.29	$6.34	106
Michigan	19,506	$6.33	$6.34	38
Kentucky	17,036	$6.33	$6.34	56
Arkansas	16,328	$6.31	$6.34	110
Hawaii	15,398	$6.31	$6.34	5
Indiana	14,856	$6.32	$6.34	57
New Mexico	13,988	$6.32	$6.34	14
South Dakota	10,045	$6.33	$6.34	67
North Dakota	7,071	$6.33	$6.34	59
Connecticut	6,918	$6.33	$6.34	56
Maine	6,805	$6.32	$6.34	37
Utah	5,944	$6.33	$6.34	41
Puerto Rico	5,580	$6.30	$6.34	43
Rhode Island	5,459	$6.33	$6.34	5
New Hampshire	4,361	$6.33	$6.34	48
Delaware	4,265	$6.34	$6.34	6
Montana	3,450	$6.33	$6.34	14
West Virginia	3,223	$6.32	$6.34	15
Wyoming	2,633	$6.31	$6.34	43
Alaska	2,113	$6.31	$6.34	33
Idaho	1,923	$6.31	$6.34	23
Vermont	1,248	$6.32	$6.34	32
District of Columbia	207	$6.34	$6.34	2
Guam	15	$6.09	$6.34	1
AP	11	$6.34	$6.34	1

Related codes

85025Complete blood cell count (red cells$7.59
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.