Billing and Coding: Laboratory Panels (A56473)



Contractor NameContract NumberStates
Novitas Solutions, Inc. 04111 - A and B MAC Colorado
04112 - A and B MAC Colorado
04211 - A and B MAC New Mexico
04212 - A and B MAC New Mexico
04311 - A and B MAC Oklahoma
04312 - A and B MAC Oklahoma
04411 - A and B MAC Texas
04412 - A and B MAC Texas
04911 - A and B MAC Colorado
New Mexico
Oklahoma
Texas
07101 - A and B MAC Arkansas
07102 - A and B MAC Arkansas
07201 - A and B MAC Louisiana
07202 - A and B MAC Louisiana
07301 - A and B MAC Mississippi
07302 - A and B MAC Mississippi
12101 - A and B MAC Delaware
12102 - A and B MAC Delaware
12201 - A and B MAC District of Columbia
12202 - A and B MAC District of Columbia
12301 - A and B MAC Maryland
12302 - A and B MAC Maryland
12401 - A and B MAC New Jersey
12402 - A and B MAC New Jersey
12501 - A and B MAC Pennsylvania
12502 - A and B MAC Pennsylvania
12901 - A and B MAC Delaware
District of Columbia
Maryland
New Jersey
Pennsylvania

Article Information

Article ID Number: A56473 Status: A-Approved

Article Title: Billing and Coding: Laboratory Panels

Original Article Effective Date: 04/11/2019

Revision Effective Date: 11/21/2019

Article Text:

Basic correct coding instructs that providers will report the Healthcare Common Procedure Code System (HCPCS) and/or Current Procedural Terminology (CPT) code that describes the procedure/service rendered to the greatest specificity as possible. Multiple HCPCS/CPT codes shall not be reported if there is a single HCPCS/CPT code that describes the service. Reporting multiple HCPCS/CPT codes when there is a single code that describes the service is considered unbundling and is inappropriate coding.

The Current Procedural Terminology (CPT) Manual defines organ and disease specific panels of laboratory tests. Organ or Disease – Oriented Panels are represented by CPT codes 80047 through 80076. Each CPT code includes a list of the defined components that are included in the specific panel.

Coding Information

Consistent with National Correct Coding Initiative (NCCI) Edits when a laboratory performs all of the tests included in one of the panel CPT codes they shall report the CPT code for the panel. In these instances it is not appropriate to report the individual tests. For example, when a physician orders cholesterol, triglycerides, and HDL cholesterol the service shall be reported as a lipid panel with CPT code 80061.

Claims submitted with individual lab tests that are part of a specific panel will be returned to the provider as unprocessable. For example a one day (from/thru dates equal) professional claim reporting CPT codes 82330, 82374, 82435, 82565, 82947, 84132, 84295 and 84520 will be returned to the provider because the individual tests are included in a basic metabolic panel (calcium, ionized) and should have been reported with CPT code 80047.

Providers should refer to the NCCI Policy Manual Chapter 1, Section N – Laboratory Panel and Chapter 10, Section C – Organ or Disease Oriented Panels for complete billing and coding information.

Coding Information
Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

999Not Applicable

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

99999 Not Applicable

CPT/HCPCS Codes:

Group 1 Paragraph:

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.



Group 1 CPT Codes:
80047 BASIC METABOLIC PANEL (CALCIUM, IONIZED) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, IONIZED (82330) CARBON DIOXIDE (BICARBONATE) (82374) CHLORIDE (82435) CREATININE (82565) GLUCOSE (82947) POTASSIUM (84132) SODIUM (84295) UREA NITROGEN (BUN) (84520)
80048 BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310) CARBON DIOXIDE (BICARBONATE) (82374) CHLORIDE (82435) CREATININE (82565) GLUCOSE (82947) POTASSIUM (84132) SODIUM (84295) UREA NITROGEN (BUN) (84520)
80051 ELECTROLYTE PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CARBON DIOXIDE (BICARBONATE) (82374) CHLORIDE (82435) POTASSIUM (84132) SODIUM (84295)
80053 COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (82247) CALCIUM, TOTAL (82310) CARBON DIOXIDE (BICARBONATE) (82374) CHLORIDE (82435) CREATININE (82565) GLUCOSE (82947) PHOSPHATASE, ALKALINE (84075) POTASSIUM (84132) PROTEIN, TOTAL (84155) SODIUM (84295) TRANSFERASE, ALANINE AMINO (ALT) (SGPT) (84460) TRANSFERASE, ASPARTATE AMINO (AST) (SGOT) (84450) UREA NITROGEN (BUN) (84520)
80061 LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DIRECT MEASUREMENT, HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL) (83718) TRIGLYCERIDES (84478)
80069 RENAL FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) CALCIUM, TOTAL (82310) CARBON DIOXIDE (BICARBONATE) (82374) CHLORIDE (82435) CREATININE (82565) GLUCOSE (82947) PHOSPHORUS INORGANIC (PHOSPHATE) (84100) POTASSIUM (84132) SODIUM (84295) UREA NITROGEN (BUN) (84520)
80076 HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (82247) BILIRUBIN, DIRECT (82248) PHOSPHATASE, ALKALINE (84075) PROTEIN, TOTAL (84155) TRANSFERASE, ALANINE AMINO (ALT) (SGPT) (84460) TRANSFERASE, ASPARTATE AMINO (AST) (SGOT) (84450)


ICD-10 Codes That Are Covered

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Medicare is establishing the following limited coverage for CPT/HCPCS codes: N/A

XX000 Not Applicable
ICD-10 Codes That Are Not Covered

XX000


Revision History Information
Revision History DateRevision History NumberRevision History Explanation
01/01/2021
R2

Article revised and published on 02/18/2021 effective for dates of service on and after 01/01/2021 to reflect the Annual HCPCS/CPT Code Updates. For the following CPT codes either the short description and/or the long description was changed. Depending on which description is used in this article, there may not be any change in how the code displays: 80047 and 80048 in Group 1 CPT Codes. Minor formatting changes made throughout the coding section.

11/21/2019
R1

Article revised and published on 11/21/2019 consistent with CMS Change Request 10901. Due to system changes, the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.