CBC without Differential (CPT 85027)
Medicare Rate vs. Lab Charges
Medicare pays $6.47 for this test. Labs commonly charge $25.00–$100.00. That's a 286%–1446% markup above what Medicare pays.
What This Test Is
A CBC without differential counts red blood cells, white blood cells (total), and platelets but doesn't break down white cell types. It's a simpler, cheaper version of the CBC with differential. It's used for basic screening and to detect anemia or infection.
Medicare Rate vs. Lab Charges
| Medicare Allowable Rate | $6.47 |
| Typical Lab Charge Range | $25.00–$100.00 |
| Average Markup Above Medicare | 286%–1446% |
Does Medicare Cover This Test?
Yes, Medicare Part B covers CBC without differential when medically necessary.
Common Reasons for Denial
- Ordered without clinical indication
- Screening in completely asymptomatic patient
- Duplicate test within short timeframe
- More detailed CBC with differential already done
- Routine screening without documented medical necessity
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: For basic screening or cost control. The differential costs more but adds detail. For simple anemia or infection screening, basic CBC may suffice.
A: No—it's just less detailed. Red cells, white cells, and platelets are still accurately counted. The differential (breakdown of white cell types) is just omitted.
A: Your doctor may order CBC with differential or additional tests to get more information about what's causing the abnormality.