CPT code 85014 – Hematocrit billing guide

Key takeaways

CPT code 85014 reports a standalone hematocrit run on an automated analyzer, while a spun microhematocrit by centrifuge is CPT 85013.

NCCI bundles 85014 into CBC codes 85025 and 85027 on the same date. However, modifier 59 or 91 applies only to a separate, medically necessary repeat test.

Medicare pays 85014 under the Clinical Laboratory Fee Schedule, with a 2026 national limit of $2.37.

Medical necessity requires a supporting ICD-10-CM diagnosis code, most commonly from the D50–D64 anemia range or D45 polycythemia vera.

Pabau, the practice software we build, checks eligibility through Claim.MD and tracks each 85014 claim through to the remittance.

CPT code 85014: definition, descriptor, and clinical overview

CPT code 85014 is the code for a standalone hematocrit, maintained by the American Medical Association (AMA) in the 85002-85999 hematology and coagulation subsection. Additionally, its official descriptor is “Blood count; hematocrit (Hct).” Indeed, the code covers one measurement: the share of a whole blood sample made up of red blood cells, expressed as a percentage.

Hematocrit, also called packed cell volume (PCV), gives a clinician a rapid read on a patient’s red cell mass. Instead, it’s ordered when a full blood panel isn’t needed. For example, common indications include anemia screening, monitoring for polycythemia, evaluating dehydration, or checking transfusion thresholds perioperatively.

Specifically, 85014 is the hematocrit measured on an automated or electronic cell counter. In contrast, a spun microhematocrit read from a centrifuge tube has its own code, CPT 85013.

What CPT 85014 includes and excludes

Specifically, CPT 85014 covers exactly one result: the packed cell volume percentage of red blood cells in a whole blood specimen. In fact, every other blood count measure has its own code.

What 85014 covers:

• Automated hematocrit reading from a whole blood sample on a hematology analyzer
• Point-of-care hematocrit from a CLIA-waived test system, reported as 85014-QW (see the CLIA rules below)

What 85014 does NOT cover:

• Spun microhematocrit by centrifuge (CPT 85013)
• Hemoglobin (CPT 85018 is the standalone hemoglobin code)
• Red cell indices (MCV, MCH, MCHC)
• White blood cell count or differential
• Platelet count
• A complete blood count, whether with or without differential (CPT 85025 or 85027)

For example, if a clinician orders hematocrit and hemoglobin together without a full CBC, report 85014 and 85018 on separate lines. Indeed, no two-analyte panel code exists. Therefore, a CBC code applies only when the lab performs a full CBC.

How hematocrit is performed and documented for billing

First, the testing method decides both the CPT code and the CLIA certificate you need. For example, a centrifuge result is reported with 85013, and an analyzer result with 85014. Mixing the two up, or holding the wrong certificate for the method, invites denials on audit.

Microhematocrit by centrifuge (CPT 85013)

First, blood is drawn into a capillary tube, sealed, and centrifuged for three to five minutes. Then the buffy coat separates out, and staff read the packed red cell percentage against a hematocrit reader card.

As a result, this spun microhematocrit is reported with CPT 85013, not 85014. CMS lists it as a CLIA-waived test that needs no QW modifier, so a Certificate of Waiver covers it. In addition, its 2026 Medicare limit of $7.00 is higher than the $2.37 paid for 85014.

Automated analyzer (CPT 85014)

Meanwhile, CPT 85014 is the hematocrit measured on an automated or electronic cell counter. On most hematology analyzers that test is non-waived, so the testing site needs a CLIA Certificate of Compliance or Certificate of Accreditation to bill it.

However, a few FDA-cleared point-of-care systems measure hematocrit as a CLIA-waived test. On those, report 85014 with modifier QW under a Certificate of Waiver. Likewise, if the analyzer runs a full CBC that was ordered, bill the CBC code instead. Therefore, confirm your device’s CLIA complexity before billing standalone 85014.

Documentation the chart must show to support the claim:

• Ordering provider name and NPI
• Clinical indication linked to a covered ICD-10-CM diagnosis code
• Date of service matching the lab requisition
• Method used (centrifuge for 85013, analyzer for 85014)
• CLIA certificate number on file for the testing site
• Result value with reference range

CPT 85014 vs. 85025 vs. 85027: choosing the right code

In fact, confusing 85014 with a CBC panel code, or with 85013, is a common coding error in hematocrit billing. Specifically, the decision guide below starts from how the result was produced and shows what Medicare pays for each code.

Upcoding warning: billing 85025 when only hematocrit was performed is fraudulent upcoding. Indeed, under the False Claims Act, systematic upcoding of this type exposes the practice to significant civil liability. Overall, always bill the code that matches exactly what was ordered and resulted.

NCCI bundling rules for CPT code 85014

The National Correct Coding Initiative (NCCI) treats hematocrit as a component of both CBC panel codes. When 85014 is billed on the same date of service as 85025 or 85027, NCCI edits bundle 85014 as a column 2 (component) code.

Specifically, a column 2 code isn’t separately payable when its column 1 code is billed for the same patient on the same date. Both edits carry modifier indicator 1 in the CMS NCCI PTP edit tables, so a modifier can bypass them in narrow cases.

However, modifier 59 or 91 fits only when a separate hematocrit was medically necessary later the same day, such as a repeat check after a transfusion. Notably, it can’t unbundle the hematocrit the CBC already produced, or a repeat run to confirm a result.

Therefore, when the hematocrit came from the CBC, bill the panel code (85025 or 85027) and leave 85014 off the claim. Otherwise, if only a hematocrit was performed, bill 85014 alone.

Billing CPT 85014 with specimen collection code 36415

CPT 36415 covers routine venipuncture, the act of drawing blood, separately from the laboratory analysis itself. Specifically, for most practices billing 85014, the question is whether 36415 can also be submitted on the same claim.

Notably, under NCCI, 36415 is not a column 2 component of 85014, meaning the two codes are not bundled by default. However, payer policies vary. For example, some commercial payers will deny 36415 when billed alongside low-cost laboratory codes, considering collection incidental. In contrast, others pay both.

Instead, for a fingerstick hematocrit, report capillary blood collection with CPT 36416, not 36415. In fact, submitting 36415 for a fingerstick draw is inaccurate coding that may trigger a post-payment audit.

ICD-10 codes that support medical necessity for CPT 85014

Every 85014 claim requires a supporting ICD-10-CM diagnosis code that establishes medical necessity. In addition, payers, including Medicare, review claims against Local Coverage Determinations (LCDs) issued by their Medicare Administrative Contractors (MACs). Covered diagnoses vary slightly by MAC jurisdiction, so always verify the LCD for your region.

Next, the most commonly covered ICD-10-CM codes are listed below. Additionally, annual ICD-10-CM updates take effect October 1 each year; verify codes are current before billing.

For example, a diagnosis of anemia alone (D64.9) is generally accepted as medically necessary for hematocrit testing. However, screening codes like Z13.0 may require advance beneficiary notice (ABN) in Medicare patients if the service is considered non-covered under the applicable LCD.

Medicare and payer reimbursement for CPT code 85014

Medicare pays CPT code 85014 under the Clinical Laboratory Fee Schedule (CLFS), which the Centers for Medicare and Medicaid Services (CMS) updates each year. Specifically, the 2026 national limitation amount for 85014 is $2.37, the same as hemoglobin code 85018.

By comparison, a spun microhematocrit under 85013 pays $7.00, and the CBC codes pay $7.77 (85025) and $6.47 (85027). Check the current quarterly CLFS file before quoting expected reimbursement, because CMS can revise these limits each January.

Top denial reasons for CPT 85014 and how to prevent them

Overall, most 85014 denials fall into five predictable categories. Consequently, a solid denial management workflow catches these at the front end rather than chasing appeals.

Documentation checklist for a clean CPT 85014 claim

In fact, a clean claim for CPT 85014 requires documentation that satisfies both medical necessity and technical billing requirements. The clean claim requirements for laboratory codes are straightforward, but missing any one element below triggers a preventable denial or post-payment audit finding. Therefore, your superbill should capture each of the following before the claim is submitted.

• Ordering provider documented: name, NPI, and credentials recorded in the chart and on the requisition
• Clinical indication: a covered ICD-10-CM diagnosis code linked to the order in the chart note
• Date of service: matches the lab requisition and the result report exactly
• Test method documented: microhematocrit by centrifuge (85013) or automated analyzer (85014) noted in the chart
• CLIA certificate on file: certificate number active and appropriate for the method used
• Place of Service code: correct POS for where the test was actually performed
• Result report: numerical result with reference range and units retained in the chart
• No concurrent CBC panel on same DOS: confirm 85025 and 85027 were not also ordered and billed on the same date

How claims management software protects CPT 85014 claims

For instance, without connected billing software, staff retype each lab charge into a clearinghouse portal, check coverage by phone and match remittances by hand. In short, each handoff is a chance for 85014 to go out beside a CBC, or to a payer that won’t cover the test.

Specifically, Pabau links to Claim.MD, our US clearinghouse partner. Its claims management software turns your invoice into an electronic CMS-1500 claim and sends it to thousands of US payers. Additionally, real-time eligibility checks confirm coverage before the specimen is drawn.

In addition, claim statuses and electronic remittance advice (ERA) flow back into Pabau. For example, a CO-97 bundling denial on an 85014 line shows up the day the remittance posts. As a result, your team can fix the order protocol while the date of service is still fresh.

Spot lab claim denials sooner

Pabau sends CMS-1500 claims through Claim.MD, checks eligibility in real time and brings remittances back in. See how your team can catch hematocrit denials the day they post.

Book a demo

Conclusion

In short, treat 85014 as the code for one result: a hematocrit run alone on an analyzer. Overall, before any hematocrit claim goes out, check the method in the chart, any same-day CBC and the diagnosis behind the order.

Indeed, the trade-off is small money against avoidable work. At $2.37, an 85014 line rarely justifies an appeal, so a clean first submission is the only fix that pays. In addition, a centrifuge result billed correctly as 85013 earns almost three times as much.

Therefore, if your team still keys lab charges by hand, book a demo to see how Pabau checks eligibility and tracks every hematocrit claim to payment.

Continue your research

Need to understand how clearinghouse scrubbing works before claims reach Medicare? Medical claims clearinghouse guide explains how 837P files are validated before reaching the payer.

Want to reduce the time spent on billing error corrections? Revenue cycle management overview covers the end-to-end process from patient intake to payment posting.

Looking for the denial reason codes behind your 85014 rejections? Denial codes in medical billing decodes CARC and RARC codes and maps common denial patterns to corrective actions.

Coding the anemia behind a falling hematocrit? ICD-10 code D62 covers acute posthemorrhagic anemia, a common reason for post-surgical hematocrit checks.

Monitoring a patient with polycythemia vera? ICD-10 code D45 explains how polycythemia vera is coded on lab and follow-up claims.

Frequently asked questions