CPT 85025: CBC with differential
What this code means, what it should cost, and how to dispute an overcharge.
Fair Price Reference
What is CPT 85025?
A complete blood count with automated differential — measures red cells, white cells, platelets, and the types of white cells.
Typical setting: Any setting.
What CPT 85025 should cost
The Centers for Medicare & Medicaid Services (CMS) pays approximately $8 for CPT 85025 under the 2025 Physician Fee Schedule. This is what the federal government has determined is a reasonable payment for this service.
Private insurance typically pays 1.2–1.8x Medicare rates ($10–$14). Hospital chargemaster prices for CPT 85025 often range from $30 to $150 — a markup of 3.8x to 18.8x over Medicare.
Common overcharges on CPT 85025
Often billed alongside 85027 (CBC without differential). Billing both is improper — 85025 includes the differential.
85027. Per CMS NCCI edits, these services are bundled.About Lab billing
Lab charges are the most commonly overbilled category on hospital bills, with routine tests marked up 10–50x over Medicare allowable.
Request the itemized lab bill. Compare each CPT code to Medicare allowable and flag any component codes billed alongside panel codes as improper unbundling.
How to dispute a CPT 85025 overcharge
- Request the itemized bill. You are entitled to a detailed line-by-line bill showing every CPT code billed. Ask in writing.
- Compare to Medicare allowable. If the charge exceeds 150% of Medicare ($12), you have grounds to dispute.
- Request documentation. For E&M codes, ask for the visit note. For procedures, ask for the operative report. The documentation must justify the code billed.
- Send a formal dispute letter. Cite the specific discrepancy between the documentation and the code. Reference Medicare rates and NCCI edits where applicable.
- Follow up in writing. Give the provider 30 days to respond. If they don't, escalate to the state attorney general and insurance commissioner.
Got CPT 85025 on your bill?
Upload your bill. We scan every line for overcharges, upcoding, and improper unbundling — then generate a dispute letter backed by federal law. Free for uninsured and veterans.