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Q4 2026 takes effect Oct 1, 2026. CMS published it early; dates of service before then are priced under the current release — see the current CPT 85025 rate.

CPT 85025

Blood Cell Count With Differential

Priced under CLFS

85025 · PFS Q4 2026 · Upcoming

Status X is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS published status X (statutory exclusion) for CPT 85025 in the Q4 2026 Physician Fee Schedule, with no national PFS amount. These figures take effect for dates of service beginning Oct 1, 2026. Treat the blank amount as unpriced, not as $0.

PFS status evidence

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 10,484)
Inspect PFS status evidence
Code
85025
Release
Q4 2026, revision 2
Result
Priced under CLFS

Citations

  • Establishes the PFS status (X) and the resulting pathway for this code: priced under clfs.

    Physician relative value file (PPRRVU)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

    Record details PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 10,484)
    hcpcs (col 1)
    85025
    modifier (col 2)
    blank
    status_code (col 4)
    X

    SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

    Original source file

Compact facts

Why is there no national PFS amount for 85025?

Its status indicator is X (statutory exclusion). The statutory definition of physician services does not include this item. Status X is not separately payable under the PFS.

About this code

Also known as Complete blood count (CBC)

A blood test counting red cells, white cells, and platelets, and sorting the white cells into their main types. It is one of the most widely used screening and monitoring tests. Medicare reported 26.2 million services under this code in CY2024.

Plain-language context only—not the official CPT descriptor and not coding guidance

Payment considerations Copy link

The inputs and payment rules that apply to this code. Each link jumps to its detail below.

NCCI same-day edits Applies MUE behavior Applies Other fee-schedule routing Applies
Other payment indicators (7)

Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, Contractor pricing: Does not apply.

Why would a Medicare claim for 85025 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

  • Its status indicator is X (statutory exclusion)—The statutory definition of physician services does not include this item. See status indicators
  • 8 codes form NCCI pairs with 85025 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
  • 9 codes pair with 85025 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together
  • More than 2 units per patient per date of service exceeds 85025's Medically Unlikely Edit (MUE) limit. See billing together

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

Payment review for 85025 Copy link

A blood count, a nearby blood-count method, and the specimen collection are separate services. Review the laboratory fee source, repeat-test facts, and any reflex work before calling two amounts inconsistent.

What to reconcile

  • Compare 85025 with nearby laboratory lines by performed method, not simply by the shared “CBC” shorthand.
  • Use the current CLFS source and do not interpret an unpriced PFS line as a zero-dollar allowance.
  • Treat a repeat or manual follow-up as separately payable only when the performed service and applicable edits support it.

Nearby payment lines

National Q4 2026 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

Code Office Facility
85027 Nearby blood-count service — —
85004 Differential-related laboratory line — —
36415 Separate specimen collection — —
Check an actual payment Model this code in a contract

Sources: CMS Clinical Laboratory Fee Schedule; CMS Medicare NCCI Policy Manual (2026); CMS Medicare Claims Processing Manual (Pub. 100-04).

Which billing rules and modifiers apply? Copy link

Global period: what 85025's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Can you bill it with another code? Copy link

Check a pair of codes Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 85025.

See every current NCCI pair for 85025 →

Billing together (NCCI edits) Copy link

NCCI Q4 2026

Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.

Not separately payable with 85025 on the same date of service—no modifier bypasses the edit (modifier indicator 0)

85004 85004 denies
85007 85007 denies
85008 85008 denies

Showing 3 of 8.

Separately payable with 85025 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)

80081 85025 denies
85013 85013 denies
85014 85014 denies

Showing 3 of 9.

Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.

Check a paired code or view all 17 NCCI pairs →

Medically Unlikely Edit (MUE) limit: 2 units per patient per date of service.

How has it changed? Copy link

Rate history by release Copy link

National office (non-facility) amount for 85025 across quarterly releases.

Release Status Office Facility
Q4 2026 takes effect Oct 1, 2026 X — —
Q3 2026 Jul 1, 2026 – Sep 30, 2026 X — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 X — —
When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

Usage and related codes Copy link

How often 85025 is billed Copy link

Across Original Medicare in CY2024, 85025 ranked #7 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars. It repeats: a patient billed for it in 2024 was billed 2.2 times on average that year.

Beneficiaries
11.9M
Office + facility patients combined
Services
26.2M
Times it was billed
Allowed
$199.0M
Total Medicare allowed dollars
Compare: ↑ #6 more popular · 99232 ↓ #8 less popular · 99215

2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q4 2026 fee schedule above.

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2026 release (effective October 2026). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before they ship.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 10,484)

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

This citation identifies the source release, so its evidence remains reproducible after a newer release lands.

CPT 85025 National PFS baseline: No national PFS rate (Q4 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/85025/2026/D