2025 CPT code 85004
(Active) Effective Date: N/A Revision Date: N/A Pathology and Laboratory Procedures - Automated Blood Counts Hematology and Coagulation Procedures Feed
Automated differential white blood cell (WBC) count using an automated hematology analyzer.
Modifiers may apply depending on the circumstances of service. Refer to the CPT manual and payer-specific guidelines for appropriate modifier use (e.g., modifier 59 for distinct procedural service, modifiers 90, 91, and 99 for laboratory settings and multiple tests).
Medical necessity for this test is established based on the clinical presentation of the patient, such as suspected infection, evaluation of immune function, monitoring of response to chemotherapy, or diagnosis of blood disorders. The physician should document the medical reason for ordering the test, correlating with the patient's signs, symptoms, and history.
A laboratory technician or medical technologist performs the test.A physician interprets the results and uses them for diagnosis and treatment.
In simple words: This blood test uses a machine to count and identify different types of white blood cells.The results help doctors check your immune system and diagnose health problems like infections or blood disorders.
This CPT code, 85004, represents an automated differential white blood cell (WBC) count.The procedure involves analyzing a blood sample using an automated hematology analyzer to determine the number of each type of WBC present (neutrophils, lymphocytes, monocytes, eosinophils, and basophils). The results provide information on the proportions of different WBC types and can aid in diagnosing various conditions such as infections, immune disorders, and certain blood cancers.This test is distinct from a manual differential count (85007) and is often included as part of a complete blood count (CBC) with differential (85025).Note that individual components of a CBC, such as this automated differential WBC count, may not be separately reimbursable if reported along with a comprehensive CBC test on the same day for the same patient by the same provider.
Example 1: A patient presents with symptoms of a bacterial infection. The physician orders a CBC with differential (85025), which includes code 85004, to assess the patient's WBC count and identify potential infections., A patient undergoing chemotherapy exhibits signs of low white blood cell count (leukopenia).A physician orders a CBC with differential to monitor the effects of the treatment, with 85004 providing the differential analysis of the WBCs., A patient experiences persistent fatigue. To rule out a blood disorder, the physician orders a CBC with differential, including 85004, to analyze the different types of white blood cells for any abnormalities.
* Patient demographics* Physician order for the test* Blood sample collection details (date, time, method)* Results of the automated differential WBC count* Physician's interpretation and diagnosis based on the results
** The interpretation of results and clinical decision making always requires a clinician's judgment and should not solely rely on the automated count. This test is usually performed as part of a more extensive panel, and specific payer rules and billing practices regarding bundling should be followed.
- Revenue Code: T1D (LAB TESTS - BLOOD COUNTS)
- RVU: This information varies depending on geographic location, payer, and other factors; consult a relevant fee schedule or pricing database. RVUs are not directly provided in the source.
- Global Days: Not applicable; this code represents a laboratory test, not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable; this is a laboratory test and not subject to technical component modifiers.
- Fee Schedule: Historical fee schedule data is not available in the provided sources. To obtain historical data, consult appropriate fee schedules for the relevant years and locations.
- Specialties:Hematology, Oncology, Infectious Disease, Internal Medicine, Family Medicine
- Place of Service:Office, Hospital (Inpatient or Outpatient), Clinical Laboratory, Urgent Care Facility