Complete blood count with or without automated differential WBC count

First Coast Options- MAC for Jurisdiction 9, which includes Puerto Rico, the U.S. Virgin Islands and Florida

Medicare pays for clinical laboratory services that are medically reasonable and necessary, ordered by a physician, and used by the physician in the treatment of the patient. When a physician documents an order for a complete blood count (CBC) in a patient’s medical record, Medicare will not pay for a CBC with automated differential (CPT code 85025).

In order to receive payment for a CBC with automated differential, the physician’s order must state CBC “with differential.” Even if a lab has a policy in place to always perform an automated differential with a CBC, regardless of what is included in the request/order, the physician may bill only for what is ordered in the patient’s medical record.