Comprehensive metabolic panel
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Comprehensive metabolic panel duplicate of individual components or frequency limit
Very Common80053 (comprehensive metabolic panel - CMP) includes 14 tests: glucose, calcium, sodium, potassium, CO2, chloride, BUN, creatinine, albumin, total protein, ALP, ALT, AST, bilirubin. Denied when individual components billed separately same day (duplicate), when basic metabolic panel sufficient, or when frequency limits exceeded for chronic monitoring.
Common Causes
- • CMP + individual chemistry tests same day - tests included in panel can't be billed separately
- • CMP when BMP (80048 - 8 tests) would be adequate - CMP includes liver function not always necessary
- • Repeat CMP within 3 months for stable chronic kidney disease - frequency limits
Resolution Strategy
Document need for liver function in addition to kidney/electrolytes: 'Patient with diabetes and CKD stage 3, also on statins for hyperlipidemia. CMP necessary to monitor kidney function (BUN, creatinine, electrolytes), glucose control, AND liver function (AST, ALT, bilirubin) due to statin therapy. Liver monitoring required every 6 months per statin guidelines. Last CMP 7 months ago.' Must justify why CMP needed over BMP - document need for liver function, calcium, total protein. If only monitoring kidneys/electrolytes, BMP sufficient. Cannot bill CMP + individual components same day. For routine monitoring, 3-6 month intervals appropriate.
💬 Plain Language Explanation
What this means
This is a comprehensive metabolic panel - a blood test that checks multiple things including kidney function, liver function, blood sugar, and electrolytes.
Why you might see this
This is a common lab panel that checks many health indicators at once. Your doctor likely ordered this as part of a routine check-up, to monitor a health condition, or to screen for various health issues.
Common context
Common comprehensive lab panel, often part of annual physicals or health monitoring.
What to ask your provider
"'What was this comprehensive panel checking for? Were all the results within normal ranges?'"
Relative Value Units (RVUs)
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Clinical Information
When to Use
Comprehensive metabolic panel including 14 tests: albumin, bilirubin (total), calcium, carbon dioxide, chloride, creatinine, glucose, alkaline phosphatase, ALT, AST, potassium, protein (total), sodium, and urea nitrogen (BUN)
Common Scenarios
Documentation Requirements
- Order from physician required
- Test results documented
- Normal/abnormal values reported
- Clinical interpretation if applicable
Coding Guidelines
Common Modifiers
Bundling Rules
- Panel includes 14 individual tests
- Cannot bill individual component tests separately
- Includes all listed tests in panel
Exclusions
- Do not bill individual component codes if panel billed
- Do not bill basic metabolic panel (80047) on same day
Coding Notes
Clinical scenarios
- Order from physician required
- Test results documented
- Normal/abnormal values reported
- Order from physician required
- Test results documented
- Normal/abnormal values reported
- Order from physician required
- Test results documented
- Normal/abnormal values reported
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
National Limit: $10.56
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Ask a QuestionFrequently Asked Questions
CPT 80053 is the billing code for "Comprehensive metabolic panel". Comprehensive metabolic panel including 14 tests: albumin, bilirubin (total), calcium, carbon dioxide, chloride, creatinine, glucose, alkaline phosphatase, ALT, AST, potassium, protein (total), sodium, and urea nitrogen (BUN)
CPT 80053 has a total RVU of 1.24, broken down as: Work RVU 0.08, Practice Expense RVU 1.15, and Malpractice RVU 0.01. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 80053 is "Comprehensive metabolic panel duplicate of individual components or frequency limit". 80053 (comprehensive metabolic panel - CMP) includes 14 tests: glucose, calcium, sodium, potassium, CO2, chloride, BUN, creatinine, albumin, total protein, ALP, ALT, AST, bilirubin. Denied when individual components billed separately same day (duplicate), when basic metabolic panel sufficient, or when frequency limits exceeded for chronic monitoring. Common causes include: CMP + individual chemistry tests same day - tests included in panel can't be billed separately; CMP when BMP (80048 - 8 tests) would be adequate - CMP includes liver function not always necessary. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 80053 include: Order from physician required; Test results documented; Normal/abnormal values reported; Clinical interpretation if applicable. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 80053: Panel includes 14 individual tests. Cannot bill individual component tests separately Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 80053 include: 26 (Professional component only (interpretation)), TC (Technical component only (performance)), 91 (Repeat clinical diagnostic laboratory test, same day). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 80053 is Automated testing - results typically available within hours. Time-based codes require documentation of the actual time spent providing the service.