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General Health Panel Code 80050


Question

Can we charge CPT 80053, 85025, and 84443 separately even though the General Health Panel (80050) includes these tests?  Medicare will not reimburse for the GHP, but if we charge them separately, would this be considered "unbundling?"

Answer

Medicare does not use code 80050.  The reason it’s not used is because Medicare can not set appropriate reimbursement since the code can contain different items. It can include 85027 or 85027 and 85004 or 85027 and 85007 or 85009.  Because each of these codes has a different reimbursement amount, Medicare can’t set a total price for the panel.  You must bill the components separately.

Disclaimer: All articles intended for general guidance only and not as a recommendation for a specific situation. Readers should consult an official source (AHA, AMA, etc.) or a qualified attorney for specific legal guidance.
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Comments (1) Comments
Comment By myra furnish - Mon, Sep 10th, 2012 3:45 PM
We have an authorization for code 80050 but we billed lab codes separately and we were denied for no authorization. We didnt list each one individually. I am trying to appealon this premise. Your guidance please Comment: While 80050 may be recognized by other payers, it is not by Medicare. If this procedure is performed on a Medicare patient, the component tests should be billed separately.
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