CPT 85060Laboratory

Blood smear interpretation

CPT code 85060 covers the professional interpretation of a blood smear slide by a physician or qualified professional. This involves examining a prepared blood sample under a microscope to identify abnormalities in blood cells, their shape, size, and distribution.

Showing rates for

National Average

Base Medicare rate

$22.64

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.45

PE RVU (NF)

0.22

MP RVU

0.03

Total RVU

0.7

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always document the medical necessity for manual interpretation, especially when an automated differential was performed first
Impact: Prevents medical necessity denials; approximately 15-20% denial rate when ordering indication is absent
Ensure the written interpretation includes specific morphologic findings, not just 'reviewed and normal'
Impact: Inadequate documentation is the leading cause of downcoding or denial; detailed reports support the $22.64 reimbursement
Bill 85060 separately from automated CBC with differential (85025 or 85027) only when manual review adds clinical value
Impact: Medicare and most payers allow both when medically indicated; bundling edits apply when not properly documented
Use modifier 91 for same-day repeat interpretations in monitoring scenarios, not modifier 76
Impact: Modifier 91 is specific to lab tests and prevents automatic denials; modifier 76 typically results in 50% reduction or denial
Verify CLIA certification and qualified personnel documentation are current before billing
Impact: Billing without proper CLIA certification can result in 100% recoupment plus potential OIG penalties
When billing globally (not split), do not append modifier 26 or TC
Impact: Incorrect modifier use reduces payment to partial component; global billing yields full $22.64 when both services performed

Common denials

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Frequently asked questions

What is the 2025 Medicare reimbursement rate for CPT 85060?

The 2025 Medicare national average reimbursement for CPT 85060 is $22.64 for both facility and non-facility settings. This is based on a total RVU of 0.70 (0.45 work RVU, 0.22 PE RVU, 0.03 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 85060 be billed with an automated CBC differential?

Yes, CPT 85060 can be billed separately from automated CBC with differential (85025 or 85027) when there is medical necessity for manual microscopic review. Documentation must justify why automated results alone were insufficient and show specific morphologic findings from the manual interpretation.

Who is qualified to bill CPT code 85060?

CPT 85060 must be performed or directly supervised by a physician (MD/DO) or qualified doctoral-level clinical laboratory scientist meeting CLIA high-complexity testing personnel requirements. The interpreting professional must provide a signed written report of findings.

What is the difference between CPT 85060 and 85007?

CPT 85007 is the technical component for blood smear preparation only, while 85060 represents the professional interpretation of the prepared smear. When one entity performs both services, 85060 is typically billed globally; when separated, 85007 captures the technical work and 85060 with modifier 26 captures interpretation.

Do I need modifier 26 when billing CPT 85060?

Use modifier 26 only when billing for the professional interpretation component separately because the technical preparation was performed by a different entity. If your facility performs both the smear preparation and interpretation, bill 85060 without modifiers for the global service.

How many RVUs is CPT code 85060 worth in 2025?

CPT 85060 has a total RVU value of 0.70 in 2025, consisting of 0.45 work RVUs, 0.22 practice expense RVUs (both facility and non-facility), and 0.03 malpractice RVUs according to the CMS Physician Fee Schedule.

What documentation is required to bill CPT 85060?

Required documentation includes a written, dated, and signed interpretation report that describes RBC morphology, WBC differential with morphologic details, platelet assessment, identification of abnormalities, clinical correlation, and diagnostic impression. The report must meet CLIA requirements for interpretive reports and demonstrate medical necessity for the manual review.