How much does Medicare pay for CPT 85049?

Medicare allowed an average of $4.37 per service and paid $4.37 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $16.67, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 85049?

Platelet count, automated test. It was billed 28,960 times to 22,051 Medicare beneficiaries by 181 providers in 2024.

Which specialty bills 85049 most?

Clinical Laboratory, with 25,741 services from 135 clinicians. Next are Family Practice, Rheumatology, Internal Medicine.

CPT 85049

Platelet count, automated test

$4.37Medicare-allowed amount per service, averaged across 28,960 services

Providers submitted

$16.67

Asking price, not received

Medicare allowed

$4.37

The fee schedule figure

Medicare paid

$4.37

Balance is patient coinsurance

Providers submitted an average of $16.67 for this code and Medicare allowed $4.37 — 3.8× 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 $4.37 (100%); the rest is the patient’s coinsurance and deductible.

Services: 28,960
Beneficiaries: 22,051
Providers billing it: 181
Total allowed: $126,555

What Medicare pays for CPT 85049

Across 28,960 services billed by 181 providers to 22,051 beneficiaries, Medicare allowed an average of $4.37 per service. That is 1.3 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 85049

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	25,741	20,099	$4.38	135
Family Practice	1,063	488	$4.39	6
Rheumatology	548	183	$4.39	1
Internal Medicine	410	332	$4.00	11
Pathology	348	278	$4.39	9
Nurse Practitioner	259	202	$4.29	5
Endocrinology	196	187	$4.28	6
Cardiology	147	106	$4.39	1
Hematology-Oncology	116	56	$4.35	4
Interventional Cardiology	80	74	$4.39	1
Physician Assistant	52	46	$4.39	2

85049 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
Alabama	5,276	$4.37	$4.39	4
Florida	3,784	$4.39	$4.39	15
California	2,538	$4.39	$4.39	16
New Jersey	2,299	$4.39	$4.39	10
New York	1,746	$4.39	$4.39	9
North Carolina	1,540	$4.38	$4.39	6
Ohio	1,425	$4.38	$4.39	7
Texas	1,222	$4.38	$4.39	11
Arizona	1,072	$4.39	$4.39	5
Georgia	1,020	$4.39	$4.39	2
Wisconsin	866	$4.03	$4.39	8
Minnesota	793	$4.38	$4.39	15
Nevada	672	$4.39	$4.39	2
Illinois	563	$4.39	$4.39	7
Massachusetts	505	$4.39	$4.39	4
Kansas	423	$4.39	$4.39	4
Tennessee	390	$4.38	$4.39	4
Washington	348	$4.35	$4.39	4
Maryland	317	$4.39	$4.39	5
Hawaii	312	$4.32	$4.39	2
Pennsylvania	308	$4.39	$4.39	4
New Hampshire	175	$4.37	$4.39	4
South Dakota	171	$4.39	$4.39	2
Virginia	157	$4.14	$4.39	5
Iowa	154	$4.36	$4.39	3
Arkansas	147	$4.39	$4.39	2
Mississippi	133	$4.38	$4.39	1
Louisiana	112	$4.36	$4.36	3
Michigan	98	$4.37	$4.39	3
Colorado	95	$4.39	$4.39	3
Oregon	59	$4.39	$4.39	2
Kentucky	56	$4.39	$4.39	2
Oklahoma	49	$4.39	$4.39	1
Connecticut	32	$4.39	$4.39	1
New Mexico	27	$4.39	$4.39	1
Rhode Island	23	$4.39	$4.39	1
Utah	20	$4.39	$4.39	1
South Carolina	19	$4.39	$4.39	1
Missouri	14	$4.39	$4.39	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.