CPT code 85025: Complete Blood Count (CBC) with Automated Differential White Blood Cell (WBC) Count

What is CPT code 85025?

The 85025 CPT code is used to report a complete blood count (CBC) with an automated differential white blood cell (WBC) count. This test provides a comprehensive evaluation of red blood cells, white blood cells, and platelets, along with a differential count identifying the percentage of different types of WBCs. It is commonly used to detect blood disorders, monitor treatment response, and evaluate overall health.

Unlike a basic CBC, CPT 85025 includes an automated differential WBC count, which uses laboratory instruments to categorize WBC types without the need for manual microscopy. This code is distinct from CPT 85027, which reports a CBC without the differential component.

Documentation requirements

To support medical necessity and ensure accurate billing, documentation for CPT 85025 must meet the following criteria:

• Medical rationale for the CBC: Include clinical indications such as infection, anemia, fatigue, or monitoring of chronic conditions that justify ordering a comprehensive blood count.
• Components measured: Confirm that the lab performed a CBC including WBC, RBC, platelet count, hemoglobin, hematocrit, and an automated differential WBC count.
• Automated method used: Note that the differential was performed using automated instrumentation rather than manual cell count or microscopy.
• Patient condition or diagnosis: Link the test to the relevant ICD-10 code or diagnosis to support insurance provider coverage requirements.
• Signature and date: Ensure the ordering provider has signed and dated the lab request or clinical note.
• Retention of results: Include lab reports in the patient record, especially if results guide treatment decisions or referrals.

Billing guidelines

To comply with medical billing services and payer requirements, the following billing lab test best practices apply to CPT 85025:

• Use the correct CPT code: Select 85025 only when the CBC includes an automated differential. If a manual differential WBC count or blood smear with microscopic examination is performed, additional or different CPT codes may be required (e.g., 85007 or 85060).
• Avoid duplicate billing: Do not separately bill components of the CBC (e.g., hemoglobin or WBC count) if they’re included in 85025.
• One unit per test: Report only one unit per encounter unless repeat testing is clinically justified and documented.
• Bundling with other lab panels: CPT 85025 may be billed with other panels (e.g., comprehensive metabolic panel) if medically necessary and supported by documentation. However, watch for bundling edits or denials from certain insurance providers.
• Coverage and reimbursement: Medicare and commercial payers typically cover CPT 85025 when ordered for a medically necessary reason. Proper use of diagnosis codes ensures accurate reimbursement.
• Performed by certified labs: Ensure the laboratory services provider meets CLIA certification requirements to perform and report automated CBC testing.
• Accurate documentation for accurate billing: Incomplete or unclear documentation may result in denied claims, delays, or underpayment. Accuracy is key to aligning with insurance provider policies and maintaining compliance.

Other relevant codes

• 85027: Complete blood count (CBC) performed using automated laboratory methods without differentials
• 85007: Complete blood count (CBC) with differential