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Last Modified: 12/2/2017 Location: FL, PR, USVI Business: Part B

Automated multi-channel chemistry (AMCC) & lab panel pricing FAQ

Q: How are automated multi-channel chemistry (AMCC) and lab panel tests priced?
A: Pricing for automated multi-channel chemistry (AMCC) and organ or disease panel tests is based on the total number of automated tests performed on the same day, for the same patient, by the same provider.
A physician may order individual tests or the panel for the 23 automated multi-channel tests, or a mix of individual tests and panels. All tests must be reasonable and necessary. Physicians should review the tests in each panel to avoid ordering duplicate tests that may result in duplicate claims. If a test is duplicated because test results are medically necessary on the same day, modifier 91 may be used. Click here for information on preventing duplicate claim denials.
Pricing examples include:
If five individual automated tests are billed, payment is made based on five tests.
If an organ and disease panel that includes seven automated tests is billed with an individual automated test not included in the panel, payment is based on eight tests.
If an organ and disease panel that includes seven automated tests is billed with an individual automated test that is included in the panel, payment will be made based on seven tests.
If two or more panel tests are billed and include duplicate individual tests, the duplicate tests are not paid. For example, if one panel includes five tests and the other includes seven tests but one of the individual tests is included in both panels, payment will be based on 11 tests.
Automated test pricing can be found on the fee schedule lookup tool. Select ‘Clinical Labs Fee Schedule’ and key the appropriate code listed below to find the allowable:

Number of automated tests
ATP codes used for pricing only
1-2
ATP02
3
ATP03
4
ATP04
5
ATP05
6
ATP06
7
ATP07
8
ATP08
9
ATP09
10
ATP10
11
ATP11
12
ATP12
13-16
ATP16
17-18
ATP18
19
ATP19
20
ATP20
21
ATP21
22
ATP22
23
ATP23

Table of chemistry panel codes:

   
Hepatic Function Panel
80076
Basic Metabolic Panel (Calcium ionized)
80047
Basic Metabolic Panel (Calcium total)
80048
Comprehensive Metabolic
Panel
80053
Renal Function Panel
80069
Lipid Panel
80061
Electrolyte Panel
80051
Automated test
Current Procedure Terminology (CPT®)
             
Albumin
82040
X
   
X
X
   
Alkaline phosphatase
84075
X
   
X
     
ALT (SPGT)
84460
X
   
X
     
AST (SGOT)
84450
X
   
X
     
Bilirubin, total
82247
X
   
X
     
Bilirubin, direct
82248
X
           
Calcium
82310
   
X
X
X
   
Calcium ionized
82330
 
X
         
Chloride
82435
 
X
X
X
X
 
X
Cholesterol
82465
         
X
 
CK, CPK
82550
             
CO2 (bicarbonate)
82374
 
X
X
X
X
 
X
Creatinine
82565
 
X
X
X
X
   
GGT
82977
             
Glucose
82947
 
X
X
X
X
   
LDH
83615
             
Phosphorus
84100
       
X
   
Potassium
84132
 
X
X
X
X
 
X
Protein
84155
X
   
X
     
Sodium
84295
 
X
X
X
X
 
X
Triglycerides
84478
         
X
 
Urea nitrogen (BUN)
84520
 
X
X
X
X
   
Uric acid
84550
             
Note: CPT® code 83718 is billed with organ/disease panel 80061 but is not included in the AMCC bundling.
Source: CMS internet-only manual (IOM), publication 100-04, Chapter 16 external pdf file, section 90-90.5
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Source: First Coast Education Action Team
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