Pathology/Lab Coding Alert

Question: We-ve seen our payment drop for the basic metabolic panel code that CPT introduced in 2008. What is the reason for the payment change?

Georgia Subscriber

Answer: Effective July 1, 2008, Medicare updated the payment rate for the basic metabolic panel that includes ionized calcium (80047, Basic metabolic panel [calcium, ionized]). You-ll now receive the same payment for that panel as you will for 80048 (Basic metabolic panel [calcium total]), which is $11.83 in most areas.

Since the first of the year when CPT added 80047, Medicare has paid for the new panel at the same rate as an automated seven-test panel (ATP07, national limit amount $11.42) plus the rate for a stand-alone ionized calcium test (82330, Calcium; ionized), which the clinical laboratory fee schedule caps at $19.09. That put the 80047 total at $30.51 instead of the current $11.83.

Look ahead: The American Clinical Laboratory Association (ACLA) and the Clinical Laboratory Management Association (CLMA) requested that CMS revert to the original payment scheme. According to these professional groups, labs must run the ionized calcium test on a separate instrument that is not part of the automated chemistry panel. Unlike 80047, labs can run 80048 as an automated chemistry panel that includes the total calcium test on a single analyzer.