Hemoglobin and Hematocrit Test Cost and Medicare Coverage

Also called: hemoglobin test · hematocrit test · platelet count · white blood count (WBC) · CBC without differential · CBC w/o Diff · hemogram · blood smear · blood differential — all the same test, CPT 85018 (related codes: 85014, 85013, 85027, 85004, 85007, 85008, 85048, 85049, 85032).

The short answer

Covered whenever there is a medical reason on the order, and the policy is written the other way around from Medicare’s other lab rules. The other lab policies come with a list of diagnoses that support the test. The blood-count policy (NCD 190.15, the same in every state) takes what CMS’s coding manual calls an “exclusionary” approach: it comes with a list of diagnoses that do not. Its covered-code section reads, in full: “Any ICD-10-CM code not listed in either the non-covered section or the medical necessity section.” If the reason on your order is not on the non-supporting list, the test is covered.

That makes this the easiest lab policy to satisfy, with three catches this page exists to explain:

• Screening is not covered. A blood count on a person with no symptoms and no condition that could affect the blood is screening, and the general-exam and blood-screening diagnosis codes are on Medicare’s non-covered code list for lab tests.
• If your doctor orders only a hemoglobin or hematocrit, the rest of a CBC is not covered. The policy says so in one sentence.
• Repeats need a reason. One blood count may be all that is appropriate for some symptoms; a repeat is expected to follow an abnormal result or a change in your condition.

This page covers the individual components: hemoglobin (CPT 85018), hematocrit (85014 and 85013), the platelet count (85049), the white blood count (85048), the differential (85004 and 85007), the blood smear (85007 and 85008), a manual cell count (85032), and the CBC without differential (85027). The full CBC with differential, CPT 85025, has its own page under the same policy.

What each component measures, and what “ordered alone” means

Medicare’s policy explains why these are usually run together: “These measurements are usually performed on a multichannel analyzer that measures all of the parameters on every sample.” Each can still be ordered and billed on its own.

• Hemoglobin (CPT 85018, Medicare pays $2.37) measures the level of hemoglobin in your blood. MedlinePlus says it is “often used to check for anemia”; Quest calls it the “usual method for determining anemia,” and Labcorp lists it for evaluating anemia, blood loss, hydration, a suspected polycythemic condition, and response to treatment. Ordered alone: the policy says it “may be appropriate to perform only a hemoglobin or hematocrit to assess the oxygen carrying capacity of the blood,” and when that is what the doctor asks for, the remaining components of a CBC are not covered.
• Hematocrit (CPT 85014, $2.37; spun microhematocrit 85013, $7.00) measures the amount (percent) of your blood that is made up of red blood cells. MedlinePlus lists it for routine checkups, cancer and treatment monitoring, and symptoms such as shortness of breath, weakness, fatigue, headache, dizziness, itching after bathing, and unusual bleeding. Ordered alone: the same hemoglobin-or-hematocrit rule applies.
• Platelet count (CPT 85049, $4.48) is “most often used to monitor or diagnose conditions that cause too much bleeding or clotting” (MedlinePlus), and is also done before surgery in people with a bleeding history. Ordered alone: the policy lists platelet-count reasons separately from the red-cell and white-cell reasons: bleeding, thrombosis, purpura, petechiae, heparin therapy, suspected disseminated intravascular coagulation, and massive transfusions, among others. One of those, or a diagnosis that is not on the non-supporting list, belongs on the order.
• White blood count (CPT 85048, $2.54) measures the number of white blood cells and is “most often used to help diagnose or monitor disorders related to having a high white blood cell count or low white blood cell count” (MedlinePlus), with fever, chills, body aches, a wound that will not heal, and an ongoing cough among the symptoms that prompt it. Ordered alone: Cleveland Clinic notes that “your provider can order a CBC with just total white blood cell counts or with a differential.” The policy’s white-cell reasons include leukemia, infections and inflammatory processes, immune disorders, and “use of drugs that may cause leukopenia.”
• Blood differential (CPT 85004 automated, $6.47; 85007 manual, on a smear, $3.80) measures the amount of each type of white blood cell: neutrophils, lymphocytes, monocytes, eosinophils, and basophils (MedlinePlus). It is what turns a hemogram into a full CBC.
• Blood smear (CPT 85008 without a manual differential, $3.43; 85007 with one, $3.80) is a slide of your blood read through a microscope by “a hematologist or a hematopathologist” (Cleveland Clinic). MedlinePlus says it is used to help diagnose and monitor a wide variety of blood disorders and is often ordered to “confirm abnormal CBC results by checking the size and number of your cells,” and that “a blood smear alone can’t diagnose a disease.” Ordered alone: Cleveland Clinic describes it as the follow-up when a routine CBC finds a problem: “A routine complete blood count detects issues with your blood cells or platelets. Your provider may order a PBS to learn more.”
• Manual cell count (CPT 85032, $4.31) appears on the policy’s code list with the descriptor “manual cell count, each.”
• CBC without differential (CPT 85027, $6.47) is what the policy calls the hemogram: “enumeration of red blood cells, white blood cells, and platelets, as well as the determination of hemoglobin, hematocrit, and indices.” Quest’s version (test 1759, “CBC w/o Diff”) reports WBC, RBC, hemoglobin, hematocrit, MCV, MCH, MCHC, RDW, and the platelet count; Labcorp’s (test 028142) reports the same set. Add a differential and it becomes the CBC with differential, CPT 85025, on its own page.

When Medicare DOES cover it

The policy says blood counts “are used to evaluate and diagnose diseases relating to abnormalities of the blood or bone marrow,” including anemia, leukemia, polycythemia, and too many or too few platelets, plus the “many other conditions” that affect the blood secondarily, “including reaction to inflammation and infections, coagulopathies, neoplasms and exposure to toxic substances,” and the “many treatments and therapies” whose effects on the blood or bone marrow are monitored with a count. Its examples, in plain English:

• Bone marrow problems: from cancer, from a drug, from a toxic exposure, or from pregnancy; suspected marrow failure; blood cells being destroyed in the circulation; immune disorders
• Red-cell and anemia signs: pallor, weakness, fatigue, bleeding, a positive stool blood test, malnutrition, a known cancer, fainting, heart failure, jaundice
• Too many red cells (polycythemia)
• White-cell reasons for a count with a differential: leukemia, infections and inflammatory processes, drugs that can lower the white count, immune disorders, fever and chills
• Platelet reasons: bleeding, clots, purpura, petechiae, heparin therapy, suspected disseminated intravascular coagulation, massive transfusions
• Specific blood conditions and exposures: thalassemia, a hemoglobinopathy, lead or arsenic poisoning, spherocytosis, storage diseases, treatment with G-CSF or GM-CSF, and two named conditions, May-Hegglin and Wiskott-Aldrich

And, because of the way this policy is built, any diagnosis that is not on the non-supporting list. If one of these genuinely describes your situation, the diagnosis for it belongs on your doctor’s order, and coverage follows.

When Medicare does NOT cover it

• Screening. The policy’s first limitation, in its own words: “Testing of patients who are asymptomatic, or who do not have a condition that could be expected to result in a hematological abnormality, is screening and is not a covered service.” The code list makes that concrete. The non-covered codes that apply to every lab policy include the general adult medical examination codes (Z00.00 and Z00.01) and Z13.0, “Encounter for screening for diseases of the blood and blood-forming organs.” A blood count added to a wellness visit with nothing else on the order lands here.
• The rest of a CBC when only hemoglobin or hematocrit was ordered. “When the ordering provider requests only hemoglobin or hematocrit, the remaining components of the CBC are not covered.” If the lab runs the full count anyway, the extra components are the ones at risk.
• Pre-surgery testing coded only as pre-surgery testing. The policy’s non-supporting list is very long (warts, carcinoma in situ, device-status codes, and dependence on renal dialysis are all on it), and it includes Z01.812, “Encounter for preprocedural laboratory examination.” That is the only mention of preoperative testing anywhere in the policy, and it is on the list of codes that do not support the test. The coding manual says the non-supporting codes have “only limited exceptions,” that “additional documentation could support a determination of medical necessity in certain circumstances,” and that it “would be appropriate for the ordering physician or the laboratory to obtain an advance beneficiary notice.” A blood count before surgery on someone with a bleeding history or a condition that affects the blood has a diagnosis of its own to carry.
• Repeats without a reason. “In some patients presenting with certain signs, symptoms, or diseases, a single CBC may be appropriate. Repeat testing may not be indicated unless abnormal results are found, or unless there is a change in clinical condition.” When a repeat is done, the policy asks for “a more descriptive diagnosis code (e.g., anemia).” It does allow repeats after normal results “in patients with conditions where there is a continued risk for the development of hematologic abnormality.”
• Dialysis patients, without paperwork. A blood count for an end-stage renal disease patient that is billed outside the ESRD rate needs “documentation of the medical necessity for the blood count” submitted with the claim.

(Never ask anyone to change a code just to get coverage; that is fraud. But doctors often have a legitimate reason for the test that simply wasn’t written down.)

What you pay if it IS covered: $0

Covered lab tests cost Medicare patients nothing, with no deductible and no 20% coinsurance. Medicare pays the lab $2.37 for a hemoglobin, $2.37 for a hematocrit, $4.48 for a platelet count, $2.54 for a white blood count, $6.47 for a CBC without differential, $6.47 for an automated differential, $3.80 for a smear with a manual differential and $3.43 for one without, $7.00 for a spun microhematocrit, and $4.31 for each manual cell count. You owe zero.

What you pay if it is NOT covered, read this before you sign

Quest’s own test directory flags hemoglobin, hematocrit, the platelet count, and the CBC without differential, all four, as “subject to a Medicare Limited Coverage Policy” that “may require a signed ABN when ordering.” (Labcorp’s pages carry no such notice.) If a blood count is on your order with a screening or preprocedural code and nothing else, expect the Advance Beneficiary Notice (ABN), the signature pad, committing you to the lab’s own billing rates if Medicare denies the claim. Before you sign:

1. Ask the lab to print exactly what you would owe. You’re entitled to see the number in black and white first. For perspective: when Medicare covers these tests, it pays the lab $2.37 for a hemoglobin and $6.47 for a CBC without differential. These are among the cheapest tests a lab runs, so a large ABN figure for one of them deserves a question.
2. Ask what was ordered. If the order says only hemoglobin or hematocrit and the lab is about to run a full CBC, the extra components are the part the policy does not cover.
3. Know the direct prices: a hemoglobin sells for $5 at Jason Health (jasonhealth.com, plus their flat $18 lab-collection fee per order, one fee for the whole order), and Jason Health charges the same $5 for a hematocrit, a platelet count, or a CBC without differential. The full table is above. Quest’s consumer site, Labcorp OnDemand, and Personalabs do not sell the components alone; their smallest option is a full CBC, priced on the CBC page. Same certified labs, same blood draw.

Before you sign the pad, 60-second checklist

1. Ask: “Can you print what I’ll owe if Medicare doesn’t pay?”
2. Ask your doctor: “Is there a symptom, condition, or medication behind this count, and is that on the order?”
3. Compare the printed price to the direct-purchase prices before deciding how to proceed.

What counts as a “normal” hemoglobin, hematocrit, platelet, or white cell count

Start with the range printed on your own report. Published ranges for these counts exist, they differ from source to source, and every source says to compare your result to your own lab’s range. Two of them differ within the same institution.

• Hemoglobin. The MedlinePlus Medical Encyclopedia gives 13.8 to 17.2 g/dL for men and 12.1 to 15.1 g/dL for women, adding that “normal value ranges may vary slightly among different laboratories.” Cleveland Clinic’s hemoglobin page gives 12 to 17.4 g/dL for adults, and says “levels may vary depending on your age, race and sex.”
• Hematocrit. The MedlinePlus encyclopedia gives 37% to 48% for men and 34% to 43% for women, and says “normal value ranges vary slightly among different labs.” Cleveland Clinic gives 41% to 50% for males and 36% to 44% for females, and says “the range for what counts as normal can vary by lab. This is why you should compare your results to the reference range in your results.”
• Platelets. Cleveland Clinic says a count “between 150,000 and 400,000 platelets per microliter of blood is considered normal, regardless of age.” The MedlinePlus platelet page prints no numbers.
• White blood cells. Cleveland Clinic’s CBC page gives 4,000 to 10,000 cells per microliter; its separate white blood cells page gives 4,000 to 11,000. Two figures from the same institution, which is the point: the upper edge of “normal” depends on who is drawing the line. The MedlinePlus white blood count page prints no numbers.
• Blood smear. There is no range. Cleveland Clinic says smear results are not “positive or negative”; a specialist describes what the cells look like.

None of the sources we checked gives a treatment target for any of these counts, so there is no “clinical target” to add here. Cleveland Clinic notes that its CBC ranges also shift with hormone status, age, pregnancy, and the units a lab reports in.

(Where lab ranges and “optimal” ranges come from, and who decides.)

This page can tell you where those numbers came from. It cannot tell you what yours means; that reading belongs to your doctor, alongside your history and your other results.

Quick questions people ask

What is the difference between a CBC, a CBC without differential, and a hemogram? Medicare’s policy defines them: “The complete blood count (CBC) includes a hemogram and differential white blood count (WBC). The hemogram includes enumeration of red blood cells, white blood cells, and platelets, as well as the determination of hemoglobin, hematocrit, and indices.” So a hemogram and a CBC without differential (CPT 85027) are the same thing, and adding the differential makes it CPT 85025. Quest lists its CBC without differential as “CBC w/o Diff.”

Do you have to fast for a hemoglobin, hematocrit, or platelet count? No. Every source we checked says no special preparation is needed for any of these, and Cleveland Clinic’s hematocrit page says you can “eat, drink and continue taking medicines as you normally would.” MedlinePlus adds one caution for hemoglobin: “If your provider has ordered other blood tests, you may need to fast.” Our fasting guide explains what fasting means and what you can still drink.

Is a blood count covered before surgery? Not on the strength of the pre-surgery code alone. Z01.812, “Encounter for preprocedural laboratory examination,” is on this policy’s list of diagnoses that do not support the test. MedlinePlus notes that platelet counts are done before surgery in people with a bleeding history, and a history like that has its own diagnosis, which is what belongs on the order.

Why would a covered blood count be denied? Usually paperwork, not policy. In CMS’s own compliance data for blood count lab tests, “insufficient documentation accounted for 92.2% of improper payments” in the 2024 reporting period; incorrect coding was 0.3%. The reason for the test has to be in the record, not just in the doctor’s head.

Why did my doctor order a blood smear after my CBC? Because the smear is the follow-up. MedlinePlus says it is often ordered “to confirm abnormal CBC results by checking the size and number of your cells,” and Cleveland Clinic describes it as the next step when a routine CBC detects an issue. A smear can also be ordered for fatigue, jaundice, bleeding, bruising, fever, or bone pain. It cannot diagnose a disease on its own.

Sources and data dates

Medicare payment amounts: CMS Clinical Laboratory Fee Schedule, 2026 Q3 file (national rates for 85018, 85014, 85013, 85027, 85004, 85007, 85008, 85048, 85049, and 85032). Coverage rules: CMS Medicare Coverage Database, NCD 190.15 (Blood Counts), a national policy identical in every state, and the same text in the NCD Manual, Chapter 1, Part 3. Diagnosis-code structure and the non-supporting list: CMS NCD Coding Policy Manual (ICD-10 edition) and the January 2026 Lab Code List. Denial statistics: CMS Medicare Learning Network compliance tip, Blood Count Lab Tests (02/11/2026). Test descriptions, preparation, and ranges: MedlinePlus (lab-tests pages and Medical Encyclopedia), Cleveland Clinic, Quest tests 510, 509, 723, and 1759, Labcorp tests 005041, 005058, and 028142. Consumer prices checked September 2026. Information current as of the date shown above; coverage is always determined by Medicare when your claim is processed.

ClaraCover provides information, not medical, billing, or insurance advice. Talk to your doctor about what tests you need.