CMS Pub. 100-04, ch. 16, § 90.2

Prior to January 1, 2018, organ or disease panels must be paid at the lower of the billed

charge, the fee amount for the panel, or the sum of the fee amounts for all components.

Payment for the total panel may not exceed the sum total of the fee amounts for

individual covered tests. All Medicare coverage rules apply.

The Medicare shared systems must calculate the correct payment amount. The CMS

furnishes fee prices for each code but the A/B MAC (A) or (B) system must compare

individual codes billed with codes and prices for related individual tests. (With each

HCPCS update, HCPCS codes are reviewed and the system is updated). Once the codes

are identified, A/B MACs (A) and (B) publish panel codes to providers.

The only acceptable Medicare definition for the component tests included in the CPT

codes for organ or disease oriented panels is the American Medical Association (AMA)

definition of component tests. The CMS will not pay for the panel code unless all of the

tests in the definition are performed. If the laboratory has a custom panel that includes

other tests, in addition to those in the defined CPT or HCPCS panels, the additional tests,

are billed separately in addition to the CPT or HCPCS panel code.

NOTE: If a laboratory chooses, it can bill each of the component tests of these panels

individually, but payment will be based upon the above rules.

Effective for claims with dates of service on or after January 1, 2019, laboratories shall

bill the HCPCS panel test code and not unbundle the individual components if all

components of the HCPCS panel are performed. Claims will be returned as

unprocessable/rejected if the HCPCS panel test code is not billed. Providers and suppliers

are required to submit all AMCC laboratory test HCPCS for the same beneficiary,

performed on the same date of service on the same claim. This billing policy applies

when:

a). Submitting a complete organ disease panel; or

b). Submitting individual component tests of an organ disease panel when all components

of the panel were not performed.

TABLE OF CHEMISTRY PANELS

Hepatic

Function

Panel

80076

Basic

Metabolic

Panel

(Calcium,

ionized)

80047

Basic

Metabolic

Panel

(Calcium,

total)

80048

Comprehensive

Metabolic

Panel

80053

Renal

Function

Panel

80069

Lipid0F

1

Panel

80061

Electrolyte

Panel

80051

Chemistry CPT

Albumin 82040 X X X

Alkaline

phosphatase

84075 X X

ALT (SGPT) 84460 X X

AST (SGOT) 84450 X X

Bilirubin, total 82247 X X

Bilirubin, direct 82248 X

Calcium 82310 X X X

Calcium ionized 82330 X

Chloride 82435 X X X X X

Cholesterol 82465 X

CK, CPK 82550

CO2

(bicarbonate)

82374 X X X X X

Creatinine 82565 X X X X

GGT 82977

Glucose 82947 X X X X

LDH 83615

Phosphorus 84100 X

Potassium 84132 X X X X X

Protein 84155 X X

Sodium 84295 X X X X X

Triglycerides 84478 X

Urea nitrogen

(BUN)

84520 X X X X

Uric Acid 84550