Complete Blood Count with Differential (CBC) (CPT 85025)
Medicare Rate vs. Lab Charges
Medicare pays $7.77 for this test. Labs commonly charge $30.00–$124.00. That's a 286%–1496% markup above what Medicare pays.
What This Test Is
A CBC with differential counts different types of white blood cells, red blood cells, and platelets. It's one of the most common lab tests, used to detect infections, anemia, clotting disorders, and many other conditions. Doctors order it during routine check-ups and when evaluating symptoms.
Medicare Rate vs. Lab Charges
| Medicare Allowable Rate | $7.77 |
| Typical Lab Charge Range | $30.00–$124.00 |
| Average Markup Above Medicare | 286%–1496% |
Does Medicare Cover This Test?
Yes, Medicare Part B covers CBC with differential when medically necessary and ordered by a treating physician.
Common Reasons for Denial
- Ordered for screening only without clinical indication
- Duplicate test within short timeframe (less than 30 days)
- Ordered by provider not in established patient relationship
- No documentation of medical necessity in patient record
- Ordered as part of routine screening in completely asymptomatic patient
What To Do If You're Overcharged
If you received a lab bill that seems unusually high compared to Medicare rates:
- Check your Explanation of Benefits (EOB) from Medicare or your insurance to see what should have been paid.
- Request an itemized bill from the lab showing all charges.
- Compare to GougeStop rates for your area to see if the charge is reasonable.
- Contact the lab's billing department to dispute erroneous charges or negotiate a lower rate.
- File an appeal with Medicare if a claim was incorrectly denied.
Frequently Asked Questions
A: There's no strict limit, but Medicare expects your doctor to document medical necessity. Routine annual physicals are typically covered; multiple CBCs per month without clinical reason may be denied.
A: A regular CBC counts total white cells, red cells, and platelets. With differential, it breaks down white cell types (neutrophils, lymphocytes, etc.), giving more detail.
A: Lab overhead (staff, equipment, facilities) is significant. Uninsured and commercial insurance patients subsidize the system; they pay retail rates that cover all costs.