No longer covering 80050 for Medicare effective 01/01/2018

Effective January 1, 2018, Priority Health will no longer cover the laboratory code 80060, general health lab panel, for the Medicare product.

Code 80050 is not covered by Medicare, it is specifically excluded from coverage. So, in accordance with Medicare rules, no Pre-service Organization Determination (PSOD) is required.

Code 80050 specifically includes:

  • Comprehensive metabolic panel (80053)
  • Blood count, complete (CBC), automated, and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027)
  • Appropriate manual differential WBC count (85007 or 85009)
  • Thyroid stimulating hormone (TSH) (84443)

Help members understand

Be advised, some members may have concerns when they receive a bill for the 80050 panel because we covered it in 2017.

Questions?

For additional questions around Medicare coverage and non covered services, see our Utilization Management Program > Medicare coverage criteria section.