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.