Notification

Reimbursement for Components of Comprehensive Laboratory Panels


Notification Issue Date: 02/04/2015



Policy Attachment


Attachment to Policy # 00.01.61


Attachment:A

Policy #:00.01.61

Description:CPT Codes

Title:Reimbursement for Components of Comprehensive Laboratory Panels


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.


Reimbursement for Components of Comprehensive Laboratory Panels

When a certain number of individual component procedure codes are reported together and performed by the same professional provider or professional providers in the same group, or by the same facility healthcare system, on the same individual, and on the same date of service in all places of services, the component procedure codes will be combined into the procedure code that represents the most closely related comprehensive laboratory panel, and reimbursement will be made for the comprehensive laboratory panel:

Table 1a: Basic Metabolic Panel (Calcium, iodized)
Panel CodeComponent Code
When:
82330
is reported with 4 or more of the following:
82374
82435
82565
82947
84132
84295
84520
Reimbursement will be made for:
80047

Table 1b: Basic Metabolic Panel (Calcium, iodized)
Panel CodeComponent Code
When:
80051
82330
are reported with 1 or more of the following:
82565
82947
84520
Reimbursement will be made for:
80047

Table 2a: Basic Metabolic Panel (Calcium, total)
Panel CodeComponent Code
When 5 or more of the following are reported:
82310
82374
82435
82565
82947
84132
84295
84520
Reimbursement will be made for:
80048

Table 2b: Basic Metabolic Panel (Calcium, total)
Panel CodeComponent Code
When:
80051
is reported with 1 or more of the following:
82310
82565
82947
84520
Reimbursement will be made for:
80048

Table 3: General Health Panel
Panel CodeComponent Code
When:
80053
84443
are reported with 1 or more of the following components or component combinations:
85025
85027 + 85004
85027 + 85007
85027 + 85009
Reimbursement will be made for:
80050

Table 4: Electrolyte Panel
Panel CodeComponent Code
When 2 or more of the following are reported:
82374
82435
84132
84295
Reimbursement will be made for:
80051

Table 5a: Comprehensive Metabolic Panel
Panel CodeComponent Code
When 5 or more of the following are reported:
82040
82247
82310
82374
82435
82565
82947
84075
84132
84155
84295
84450
84460
84520
Reimbursement will be made for:
80053

Table 5b: Comprehensive Metabolic Panel
Panel CodeComponent Code
When:
80048
is reported with 1 or more of the following:
82040
82247
84075
84155
84450
84160
Reimbursement will be made for:
80053

Table 5c: Comprehensive Metabolic Panel
Panel CodeComponent Code
When:
80051
is reported with 6 or more of the following:
82040
82247
82310
82565
82947
84075
84155
84450
84460
84520
Reimbursement will be made for:
80053

Table 6: Obstetric Panel
Panel CodeComponent Code
When 1 or more of the following components or component combinations are reported:
85025
85027 + 85004
85027 + 85007
85027 + 85009
Plus each of the following:
86592
86762
86850
86900
86901
87340
Reimbursement will be made for:
80055

Table 7: Lipid Panel
Panel CodeComponent Code
When all of the following are reported:
82465
83718
84478
Reimbursement will be made for:
80061

Table 8: Renal Function Panel
Panel CodeComponent Code
When 6 or more of the following are reported:
82040
82310
82374
82435
82565
82947
84100
84132
84295
84520
Reimbursement will be made for:
80069

Table 9: Acute Hepatitis Panel
Panel CodeComponent Code
When all of the following are reported:
86705
86709
86803
87340
Reimbursement will be made for:
80074

Table 10: Hepatic Function Panel
Panel CodeComponent Code
When 4 or more of the following are reported:
82040
82247
82248
84075
84155
84450
84460
Reimbursement will be made for:
80076




Version Effective Date: 03/06/2015
Version Issued Date: 03/06/2015
Version Reissued Date:

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