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26.4.5 Complete Blood Count (CBC)
The Texas Medicaid Program considers a baseline CBC appropriate for the evaluation and management of existing and suspected disease processes. Complete blood counts should be individualized and based on client history, clinical indications or proposed therapy and will not be reimbursed for screening purposes.
The following procedure codes will be denied as part of another service when billed with procedure code 85025 for the same date of service by the same provider:
Procedure code 85004 will be denied as part of another service when billed with procedure code 85007, 85009, 85025, or 85027 for the same date of service by the same provider.
Procedure code 85007 will be denied as part of another service when billed with procedure code 85025 for the same date of service by the same provider.
Procedure code 85008 will be denied as part of another service when billed with the following procedure codes for the same date of service by the same provider:
Procedure code 85009 will be denied as part of another service when billed with procedure code 85025 for the same date of service by the same provider.
Procedure code 85013, 85014, or 85018 will be denied as part of another service when billed with procedure code 85025 or 85027 for the same date of service by the same provider.
Procedure code 85027 will be denied as part of another service when billed with procedure code 85025.
Procedure code 85032 will be denied as part of another service when billed with procedure code 85025, 85027, 85041, 85048, or 85049.
Procedure codes 85041 will be denied as part of another service when billed with procedure code 85025 or 85027.
Procedure codes 85044 will be denied as part of another service when billed with procedure code 85045 or 85046.
Procedure code 85045 will be denied as part of another service when billed with procedure code 85046.
Procedure codes 85048 will be denied as part of another service when billed with procedure code 85025 or 85027.
Procedure code 85049 will be denied as part of another service when billed with procedure codes 85025 or 85027.
A CBC is a comprehensive service that includes components.
The components of a CBC are listed in the following table:
Procedure code 85049 may be reimbursed separately If this procedure code is billed for the same date of service as procedure codes 85025 or 85027, it will deny as part of another service.
Reticulocyte procedure codes 85044, 85045, and 85046 may be reimbursed in addition to a CBC.
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