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Thread: Cmp (80053) & spep (84165)

  1. #1

    Default Cmp (80053) & spep (84165)

    Our physicians often order a CMP and protein electrophoresis together. We do a CMP (CPT code 80053) here at our facility, and send the serum protein electrophoresis to our reference lab. A total protein (CPT 84155) is a component of the CMP we do here, but it is also a component of the serum protein electrophoresis that is done at the reference laboratory. We are being reimbursed for the 80053 however our ref. lab is not being reimbursed for the 84165, how do we handle this situation?

    I just want to clarify that we are only billing for the 80053 and 84165, not 84155?

  2. #2

    Default Cpc/crcr

    Although your provider may order both at the same time, and may want the additional result you can't bill for them. I understand you bill for the 84156 only but you really getting similar results and insurance will consider these inclusive to the panel. the only time you could bill the 84155 or 84156 is if provider orders it at a later time in the day after reviewing abnormal results from the 80053 panel. Hope this help

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