Wiki 80050 - medical necessity

[alyssak88]

Hi, I know that medicare will not pay for 80050 but I have two questions regarding this:
I heard that medicare will pay for this unbundled as long as medical necessity is proven for each test not counting a screening dx, is that accurate? I have seen this come up before on the forum but it was brought up by one member and I just wanted to see if there were others out there who could verify it.

My second question is why is it that medicare will not pay 80050, is there any literature that anyone knows of that goes into why it is not considered payable by medicare?

Thank you very much!

 

[jamie@samwille.com]

It has been awhile be we are a medical billing co and we used to bill labs for providers. It is my understanding that some labs have exclusive contract with payors that simply mean you can't bill them... I know this was true for Medicare, Medicaid and some UHC plans near us. SO- even if you can technically un bundle it does not mean that you should.

 

[overnluv@yahoo.com]

80050

In our case, we are a physician's office and almost all of the lab codes we can not bill to Medicare we have to send it for the Lab company to bill Medicare.

 

[pamtc2000]

80050

Per CPT:
80050 General Health Panel - Tests in this panel should be billed individually as the components of the panel may vary. Must include 80053 and 84443, 85025 or 85027 and 85004; or 85027 and 85007 or 85009.

Other lab panels always contain the same tests, 80050 does not.