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CMS Transmittals




80047
Quick jump to procedure code: Printer Friendly Version
80050

Procedure Category: Pathology and Laboratory
Procedure Subcategory: Organ or Disease-Oriented panels

80048: METABOLIC PANEL TOTAL CA

CPT® 80048: Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520)



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CPT copyright 2018 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State
2019 Laboratory Fee Schedule: $9.40


2019A OPPS Status Indicator: Q4

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Percentage
ICD-10 Code
Description
Related DRG(s)
19.4%
I10
Essential (primary) hypertension
304-305
7.2%
E11.9
Type 2 diabetes mellitus without complications
008
010
637-639
4.0%
Z79.899
Other long term (current) drug therapy
949-950
2.8%
N18.3
Chronic kidney disease, stage 3 (moderate)
008
673-675
682-684
2.7%
D64.9
Anemia, unspecified
811-812
2.6%
E78.5
Hyperlipidemia, unspecified
642
1.9%
I50.9
Heart failure, unspecified
222-227
291-293
793
1.8%
E03.9
Hypothyroidism, unspecified
643-645
1.8%
E11.65
Type 2 diabetes mellitus with hyperglycemia
008
010
637-639
1.5%
E87.1
Hypo-osmolality and hyponatremia
640-641
793

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

80048 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.

Multiple Code CCI/MUE Edit Report-New

Column 1 CCI Edits for 80048
Denied Codes (1)
Effective
Modifier
Accepted (2)
80051 ELECTROLYTE PANEL
10/01/2006 Yes
82310 ASSAY OF CALCIUM
06/05/2000 Yes
82374 ASSAY BLOOD CARBON DIOXIDE
06/05/2000 Yes
82435 ASSAY OF BLOOD CHLORIDE
06/05/2000 Yes
82565 ASSAY OF CREATININE
06/05/2000 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
82947 ASSAY GLUCOSE BLOOD QUANT
06/05/2000 Yes
84132 ASSAY OF SERUM POTASSIUM
06/05/2000 Yes
84295 ASSAY OF SERUM SODIUM
06/05/2000 Yes
84520 ASSAY OF UREA NITROGEN
06/05/2000 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 80048.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.



Column 2 CCI Edits for 80048
Denied Codes (1) Effective Modifier
Accepted (2)
80047 METABOLIC PANEL IONIZED CA 01/01/2008 No
80053 COMPREHEN METABOLIC PANEL 06/05/2000 No
80069 RENAL FUNCTION PANEL 07/01/2001 No
(1) These codes will be denied when submitted for payment on the same date of service as 80048.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 80048


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 2 2 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Clinical: Data Clinical: Data Not Listed

* CCI Source Data: Practitioner P2P Coding Edits. For more information on these edits or to view the Hospital Outpatient Edits, please visit https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

MUE Source Data: For more information on these edits, please visit href='https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   80048 Top 5 Ordering Providers National* - Extended NPI Market Analysis Search
JON KELLER -PALO ALTO,CA 23,060
MICHAEL VALACHOVIC -DALLAS,TX 15,219
KANDICE MARCHANT -CLEVELAND,OH 9,334
EDMUND TAI -MOUNTAIN VIEW,CA 9,319
CHARLES BEAVERS -OKLAHOMA CITY,OK 7,893

   80048 Top 5 Ordering Organizations National*
LABORATORY CORPORATION OF AMERICA HOLDINGS-NC 256,680
LABORATORY CORPORATION OF AMERICA HOLDINGS-NJ 165,422
AMERATHON,LLC-OH 144,738
QUEST DIAGNOSTICS CLINICAL LABORATORIES INC-FL 120,636
SOLSTAS LAB PARTNERS GROUP LLC-NC 118,019

*Based on 2016 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 80048*         Hide this section.



Annual Performed / Denied


Total National Services (all modifiers) Submitted 2017: 7,934,335
Total Services Denied 2017: 530,213 (6.7%)
National Charges Submitted 2017: $333,422,807.07
National Charges Allowed 2017: $ 72,842,693.87
National Average (No Modifier) Fee Submitted 2017: $ 41.83
National Average (No Modifier) Fee Allowed 2017: $ 9.82
National Average (26) Fee Submitted 2017: $ 24.07
National Average (26) Fee Allowed 2017: $ 0.00
National Average (QW) Fee Submitted 2017: $ 39.86
National Average (QW) Fee Allowed 2017: $ 9.82


Top 5 Performing Specialties 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Clinical laboratory
(billing independently)
5,550,380 70.0% $ 42.78 429,471 7.7%
Internal medicine 815,121 10.3% $ 37.19 27,127 3.3%
Family practice 661,940 8.3% $ 39.65 27,452 4.1%
Pathology 131,786 1.7% $ 48.31 13,890 10.5%
Hematology/oncology
(eff 5/92)
125,713 1.6% $ 41.61 3,463 2.8%

Top 5 Places of Service 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Independent laboratory 5,372,470 67.7% $ 43.08 410,976 7.6%
Office 2,387,992 30.1% $ 40.40 90,664 3.8%
Nursing facility 132,474 1.7% $ 28.61 16,916 12.8%
Urgent Care Facility (eff. 1/1/03) 7,911 0.1% $ 40.28 773 9.8%
Federally qualified health centers (eff. 10/1/93) 6,816 0.1% $ 47.28 467 6.9%

Top 5 Modifiers Submitted 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 7,130,146 89.9% $ 41.83 479,679 6.7%
QW - CLIA Waived Category Test 379,180 4.8% $ 39.86 16,986 4.5%
90 - Reference (Outside) Laboratory 204,929 2.6% $ 42.20 17,835 8.7%
QP - Documentation is on file showing that the lab test(s) was ordered individually or ordered as a CPT recognized panel other than automated profile codes 68,666 0.9% $ 76.38 7,556 11.0%
GA - Advanced Beneficiary Notice (ABN) on File 62,496 0.8% $ 40.90 2,627 4.2%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.


   CodeMap Compliance Briefings: Hide this section.

CMS Transmittals Referencing "80048"
Issue DateTransmittalTitle
2019-01-11 R4195CP New Waived Tests
2018-12-13 R254BP Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2019
2018-11-15 R4169CP New Waived Tests
2018-11-14 R250BP Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment fo
2018-07-20 R4091CP New Waived Tests
2018-06-15 R4073CP Quarterly Update to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS)
2018-04-06 R4018CP New Waived Tests
2018-01-05 R3945CP New Waived Tests
2017-11-03 R237BP Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2018
2017-11-03 R3902CP New Waived Tests
2017-09-28 R3867CP New Waived Tests
2017-08-11 R3833CP Quarterly Update to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS)
2017-05-12 R1846OTN MCS Implementation of the Restructured Clinical Lab Fee Schedule
2017-03-30 R3741CP New Waived Tests


All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

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01/23/2019 07:19:10 54.172.221.7

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