Comprehensive metabolic panel (CMP) (CPT 80053): what Medicare pays
On a hospital bill, CPT 80053 is the code for: Blood test, comprehensive group of blood chemicals. Here is what Medicare pays for it, what is billed on average, and how to question the line on your bill.
CPT 80053 at a glance
| Medicare average allowed amount | $10.33 |
|---|---|
| Average amount billed to Medicare | $61.45 |
| Billed vs. allowed | 5.9 times |
| Services in the data | 27,211,637 |
| Setting and year | Office or clinic, national average, 2024 |
What this code is
This is a group of laboratory tests done on one blood sample and billed under a single code.
Why your hospital bill can show more
Medicare pays a national amount for each code. Hospitals set their own list prices, called the chargemaster, so a hospital bill can show a much higher amount for the same code. In a hospital or an emergency room, a separate facility charge is often added. Medicare's amount is not a price the hospital must accept, but it is a fair reference to negotiate.
Common billing problems with CPT 80053
Billed twice on the same day
The same code, on the same day and at the same price, can appear twice. Sometimes it is real (a second sample, the other side, mother and baby). Ask for the time and the reason of each one, and ask them to remove the extra charge if it was done once.
A test billed on top of its panel
A panel already includes its single tests. If the bill also lists one of those tests on the same day, ask them to remove it, unless it came from a separate blood draw.
No code on the line
If your bill shows a total without codes, ask for a fully itemized bill. Without codes, nobody can check the charges.
How to question this charge
- Ask the hospital for a fully itemized bill, with the code, date, quantity and price of every line.
- Compare the line with the Medicare amount above.
- Ask in writing for a fair price, the lowest amount they will accept, and any discount for paying in full or for patients without insurance.
- Ask for the hospital's financial assistance policy.
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Related codes
- CPT 80048: Basic metabolic panel (BMP)
- CPT 85025: CBC with differential
- CPT 85027: CBC without differential
- CPT 80061: Lipid panel (cholesterol)
- CPT 80076: Liver function panel
Frequently asked questions
How much does CPT 80053 cost?
It depends on where it is done. In 2024, Medicare's average allowed amount for CPT 80053 in an office setting was $10.33, and providers billed Medicare $61.45 on average. Hospitals can bill more. If you have no insurance, ask for the self-pay price before you pay.
Can I be billed twice for CPT 80053 on the same day?
Only if it was really done twice. Ask for the time and the reason of each line. If it was done once, ask them to remove the extra charge.
What is the difference between CPT 80053 and CPT 80048?
CPT 80053 is Comprehensive metabolic panel (CMP). CPT 80048 is Basic metabolic panel (BMP). Medicare's average allowed amounts were $10.33 and $8.27 in 2024.
How do I question this charge?
Ask for an itemized bill, compare the line with the Medicare amount, then ask in writing for a fair price and for financial assistance. BillCheck writes the letter for you.