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See a sample rate comparisonCPT 85025 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Complete Blood Count (Cbc), A Complete Blood Count Includes Red Blood Cells White Blood Cells Hemoglobin Hematocrit Platelets And Distribution Of The Cells Within The Blood Volume Sampled.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Hematology and Coagulation Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 26 - Professional component QW - CLIA Waived Tests |
| Complexity Level | Low |
| Medicare Fee Schedule | $7.77 national lab fee schedule rate (2026) · View Medicare rates for 85025 |
| Medicaid Fee Schedule | $7.15 median of the 8 states in the free preview · View Medicaid rates for 85025 |
National average reimbursement for CPT 85025 by major payers:
$7.25
$5.58
$9.94
$11.39
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CPT 85025
5 of 25 sample ratesHigher to lower in this preview
Cyerwin Monique Malvar
University Physician Associates Of New Jersey Inc
$15.92Published rateCharles Saha
Charles Saha Md PC
$4.76Published rateRana Jafri
Medical Associates Of Marlboro PC
$3.78Published rateRazia Awan
$3.53Published rateAttila Farkas
$2.60Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 85025 vs. Other Hematology and Coagulation Procedures Codes
The CPT 85025 code is part of the Pathology and Laboratory Procedures services used for Hematology and Coagulation Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 85025 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 85002-CPT | Low | Blood Clotting Test, Bleeding Time (Blood Clotting Test) Checks How Quickly The Blood Clots When A Small Skin Cut Is Made. The Test Is An Indicator Of Platelet Function (Platelets Are Blood Cells Required For Blood Clotting). |
| 85004-CPT | Low | Automated Count Of Blood Cells, Machine Blood Count Measuring The Number Of White Cells (Wbcs) Red Cells (Rbcs) And Platelets. |
| 85018-CPT | Low | Hemoglobin Count, The Hemoglobin Count Helps To Evaluate The Amount Of Iron In The Blood. It Can Be Done As Part Of A Complete Blood Count (Cbc). A Low Count Can Be An Indicator Of Anemia. |
| 85025-CPT | Low | Complete Blood Count (Cbc), A Complete Blood Count Includes Red Blood Cells White Blood Cells Hemoglobin Hematocrit Platelets And Distribution Of The Cells Within The Blood Volume Sampled. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 85025. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 85025 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Frequently Asked Questions
CPT (Current Procedural Terminology) codes are a standardized set of five-digit codes used by healthcare professionals to describe medical, surgical, and diagnostic services. They are crucial for healthcare costs because they are used by insurers and payers to determine the amount they will reimburse providers for services rendered, and by providers to bill for those services. Understanding the CPT code for a service can help you research its potential cost and understand billing.
To find out the cost of a medical procedure or service, you can start by asking your healthcare provider for the specific CPT codes associated with the service. Once you have the CPT code and your location, you can use online tools designed for price transparency. For specific, localized price lookups based on your situation, it's recommended to use tools like Payerprice's fee schedule lookup tool, which allows you to search with a CPT code and your specific location to get relevant pricing information.
While CMS (Centers for Medicare & Medicaid Services) provides valuable data, its public resources (like the Physician Fee Schedule Look-up Tool) primarily offer general payment rates for services covered by Medicare. These rates may not reflect the actual prices charged by all providers, nor do they account for variations in private insurance plans, geographic-specific commercial rates, or individual patient situations. For specific, actionable pricing information tailored to your individual circumstances and location, tools like Payerprice are generally more suitable.
Payerprice is a service that offers a fee schedule lookup tool designed to help users find specific pricing information for medical procedures. By using its tool, you can search with a CPT code and your specific location to get detailed fee schedule data. This can help you understand potential costs, compare prices, and make more informed healthcare decisions, especially when dealing with commercial insurance rates that often differ from Medicare rates.
To effectively use Payerprice's fee schedule lookup tool, you typically need two key pieces of information: the CPT (Current Procedural Terminology) code for the specific medical service or procedure you are interested in, and your specific location (e.g., zip code or city/state). This information allows the tool to provide localized and relevant pricing data that can help you estimate costs for various providers.