Organ or Disease Oriented Panels

90.2 - Organ or Disease Oriented Panels (Rev. 4299, Issued: 05-03-19, Effective: 01-01-19, Implementation: 10-07-19) 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 Lipid0F1 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