How much does Medicare pay for CPT 85097?

Medicare allowed an average of $51.39 per service and paid $40.67 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $249.30, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 85097?

Bone marrow, smear interpretation. It was billed 126,956 times to 120,134 Medicare beneficiaries by 2,083 providers in 2024.

Does 85097 pay differently in an office than a hospital?

Yes. The allowed amount averaged $69.43 in an office setting and $46.72 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 85097 most?

Pathology, with 109,488 services from 1,975 clinicians. Next are Clinical Laboratory, Hematology-Oncology, Hematology.

CPT 85097

Bone marrow, smear interpretation

$51.39Medicare-allowed amount per service, averaged across 126,956 services

Providers submitted

$249.30

Asking price, not received

Medicare allowed

$51.39

The fee schedule figure

Medicare paid

$40.67

Balance is patient coinsurance

Providers submitted an average of $249.30 for this code and Medicare allowed $51.39 — 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 $40.67 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $69.43
Hospital / facility: $46.72

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 26,083 services were billed in an office setting and 100,873 in a facility.

Services: 126,956
Beneficiaries: 120,134
Providers billing it: 2,083
Total allowed: $6,524,269

What Medicare pays for CPT 85097

Across 126,956 services billed by 2,083 providers to 120,134 beneficiaries, Medicare allowed an average of $51.39 per service. 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 85097

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pathology	109,488	103,453	$48.74	1,975
Clinical Laboratory	16,109	15,437	$69.11	76
Hematology-Oncology	531	469	$62.29	12
Hematology	377	344	$48.64	7
Medical Oncology	326	312	$51.77	9
Internal Medicine	73	70	$48.28	2
General Practice	41	38	$47.08	1
Diagnostic Radiology	11	11	$39.93	1

85097 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
California	14,163	$59.01	$42.58	191
Texas	12,138	$51.25	$40.53	175
Florida	11,507	$55.73	$43.61	135
New York	7,976	$53.92	$38.95	118
New Jersey	5,484	$66.41	$47.73	55
Pennsylvania	4,931	$47.98	$37.53	80
Illinois	4,563	$49.64	$37.92	96
Massachusetts	4,325	$49.85	$36.37	68
Arizona	3,732	$46.70	$37.50	53
Tennessee	3,489	$52.05	$43.76	39
Ohio	3,477	$45.36	$36.79	72
Minnesota	3,036	$47.26	$37.18	56
Virginia	3,012	$46.44	$36.99	55
North Carolina	2,909	$46.07	$37.50	56
Georgia	2,793	$47.44	$37.69	54
Washington	2,764	$51.21	$38.55	45
Michigan	2,726	$46.69	$36.76	69
Wisconsin	2,701	$45.80	$37.05	51
Missouri	2,659	$46.17	$36.68	45
South Carolina	2,220	$46.55	$37.30	30
Arkansas	2,208	$45.66	$38.87	25
Kansas	2,108	$44.81	$36.85	24
Maryland	2,033	$48.30	$36.19	54
Indiana	1,890	$49.20	$40.48	45
Connecticut	1,609	$59.65	$44.56	30
Oklahoma	1,606	$48.07	$39.72	19
Colorado	1,574	$46.61	$36.36	33
Iowa	1,464	$47.61	$39.01	32
Louisiana	1,210	$49.41	$40.99	22
Alabama	1,194	$50.05	$41.75	27
Utah	1,024	$46.14	$36.77	19
Oregon	919	$49.53	$37.91	19
Kentucky	902	$45.28	$36.98	22
Nevada	723	$50.07	$40.23	17
Nebraska	669	$46.82	$38.83	17
South Dakota	608	$46.02	$37.30	7
Mississippi	558	$44.30	$36.61	13
West Virginia	467	$46.02	$37.08	18
New Mexico	433	$47.15	$38.70	16
North Dakota	429	$50.55	$40.42	8
Montana	407	$47.77	$37.57	8
District of Columbia	400	$50.72	$36.55	8
New Hampshire	399	$45.44	$36.42	8
Maine	380	$45.94	$35.74	9
Vermont	301	$45.32	$35.51	11
Delaware	241	$46.17	$36.41	4
Idaho	218	$49.48	$40.58	8
Hawaii	176	$49.62	$38.63	9
Rhode Island	143	$47.06	$36.38	5
Alaska	44	$61.79	$34.98	2
Wyoming	14	$67.46	$54.09	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
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.