Laboratory Question for the Week of August 30, 2021

Question:

Is 80050 covered by Medicare?

Answer:

A general health panel (80050) is not covered by Medicare, primarily because of the diversity of test components. CMS states that no single diagnosis code would merit the diverse testing such a panel entails, and therefore the tests in this panel should be ordered individually, with appropriate medical necessity documentation. The reason for this exception is that 80050 is considered screening rather than diagnostic in nature and is, therefore, not recognized as covered under the Medicare program. From 2018 and continuing into 2021, the obstetric panels (80055 and 80081), which were previously not recognized by CMS, are payable when certain criteria are met.

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