This policy addresses coverage and reimbursement for laboratory re-bundled services.
Organ or Disease-Oriented Panels
The tests listed under each lab panel (80047-80076) identify the defined components (lab tests) of that panel.
The submission of multiple procedure codes for a group of specific procedures that are components of a single comprehensive code.
Laboratory procedures should be submitted using the CPT or HCPCS code that best describes the service.
The tests listed under each organ or disease-oriented panel (80047- 80076) identify the defined components of that panel, and all tests listed must be performed in order to bill for that panel. Tests performed in addition to those specifically indicated for a particular panel can be billed separately in addition to the panel code.
If a panel is submitted and one of the lab procedures/tests is repeated, that single repeat component may be billed with the individual service code will require submission of modifier 91 (not 59).
Lab panels should be reported as 1 line item with 1 unit per panel.
Procedure Code Unbundling/Replacement
Procedure code unbundling is the submission of multiple procedure codes for a group of specific procedures that are components of a single comprehensive code. Procedure unbundling may occur in one of two ways:
Do not report two or more panel codes comprising the same tests; report the panel with the highest number of tests to meet the definition of the code, and report the remaining tests individually.
Reimbursement policies are intended only to establish general guidelines for reimbursement under BCBSND plans. BCBSND retains the right to review and update its reimbursement policy guidelines at its sole discretion.