CPT code and description
80050 General Health Panel
80053 Comprehensive Metabolic Panel
84443 Assay Thyroid Stim Hormone
Policy Guidelines.
Individual laboratory codes, which together make up an organ or disease-oriented laboratory Panel Code, will be combined into and reimbursed as the more comprehensive laboratory Panel Code as described under the specific laboratory panel headings below. These panels are defined in the CPT book as codes 80047, 80048, 80050, 80051, 80053, 80055, 80061, 80069, 80074, 80076, and 80081. According to the CPT book, they were developed for coding purposes only and are not to be interpreted as clinical parameters. UnitedHealthcare uses CPT coding guidelines to define the components of each panel.
UnitedHealthcare also considers an individual component code included in the more comprehensive Panel Code when reported on the same date of service by the Same Individual Physician or Other Qualified Health Care Professional. The Professional Edition of the CPT ® book, Organ or Disease-Oriented Panel section states: “Do not report two or more panel codes that include any of the same constituent tests performed from the same patient collection. If a group of tests overlaps two or more panels, report the panel that incorporates the greater number of tests to fulfill the code definition and report the remaining tests using individual test codes (e.g., do not report 80047 in conjunction with 80053).”
There are 3 configurations for Panel CPT code 80053:
Configuration 1
Includes the following Component Codes:
82040, 82247, 82310, 82374, 82435, 82565, 82947, 84075, 84132, 84155, 84295, 84450, 84460, 84520
Configuration 2
Includes the following Panel Code: 80048
Plus the following Component Codes: 82040, 82247, 84075, 84155, 84450, 84460
Configuration 3
Includes the following Panel Code: 80051
Plus the following Component Codes: 82040, 82247, 82310, 82565, 82947, 84075, 84155, 84450, 84460, 84520
Do not report two or more panel codes that include the same constituent tests performed from the same patient collection
Example, If the Comprehensive Metabolic Panel (80053) is billed, the Basic Metabolic Panel (80047) cannot be billed.
If a group of tests overlaps two or more panels, you must use the panel that incorporates the greatest number of tests and report the remaining individual tests.
Example, if 82374 (Assay of Blood Carbon Dioxide), 82435 (Assay of Blood Chloride), 84132 (Assay of Serum Potassium), 84295 (Assay of Serum Sodium), 84520 (Assay of Urea Nitrogen), and 82947 (Assay Glucose Blood Quant) are billed, two panel codes overlap. The Basic Metabolic Panel (80047) and the Electrolyte Panel (80051) include codes 82374 (Assay of Blood Carbon Dioxide), 82435 (Assay of Blood Chloride), 84132 (Assay of Serum Potassium) and 84295 (Assay of Serum Sodium). The Electrolyte Panel should be billed.
Reimbursement Guidelines
A. Categories of diagnostic tests covered and not covered as routine/preventive
- Moda Health covers the preventive services mandated in the Patient Protection and Affordable Care Act (PPACA) at 100% (no cost-sharing responsibility to the member), when the member is seeing an in-network provider.
- In addition to the mandated PPACA preventive services, Moda Health also covers a limited list of additional tests when billed with a routine, preventive, or screening diagnosis code. The codes and tests eligible for this additional screening coverage are determined by a Moda Health Medical Director and are listed below.
NOTE: These tests are not eligible for the 100%, no-cost-share Affordable Care Act preventive benefit because they are not on the PPACA list of mandated preventive
services.
The tests will be covered (rather than denied), but all of the following tests are subject to the member’s usual cost-sharing and deductible requirements, even when billed with a preventive diagnosis.
For another view of this concept, see also the summary table shown under #4 below.
The following additional CPT codes will be covered as noted above when submitted with a outine/preventive/screening diagnosis as primary on the line item:
• 80048 (Basic metabolic panel)
• 80050 (General health panel)
• 80051(Electrolyte panel)
• 80053 (Comprehensive metabolic panel)
• 80061 (Lipid panel)
• 81001 (Urinalysis, by dip stick or tablet reagent; automated, with microscopy)
• 82310 (Calcium; total)
• 83036 (Hemoglobin; glycosylated (A1C))
• 83655 (Lead)
• 84443 (Thyroid stimulating hormone (TSH))
• 85025 (Blood count; complete (CBC), automated)
• Chlamydia screening for males
(Note: female Chlamydia screening covered under PPACA @ 100%)
o 87110 (Culture, chlamydia, any source)
o 87270 (Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis)
o 87490 (Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique)
o 87491 (Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique)
o 87492 (Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, quantification)
ICD-10 Codes for 80053
• Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement
• Rheumatoid arthritis without rheumatoid factor, multiple sites
• Primary generalized (osteo) arthritis
• Pain in unspecified joint
• Fibromyalgia
• Age-related osteoporosis without current pathological racture
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