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General Health Panel

 

DESCRIPTION

General health panel is set of laboratory tests consisting of a comprehensive metabolic panel, complete blood count (CBC), and thyroid stimulating hormone (TSH).

 

POLICY

General health panel is considered a not medically necessary procedure.

 

POLICY EXCEPTIONS

None

 

POLICY GUIDELINES

The coverage guidelines outlined in this Medical Policy should not be used in lieu of the Member's specific benefit plan language.

 

POLICY HISTORY

7/16/2009: Approved by Medical Policy Advisory Committee (MPAC)

11/24/2009: Policy Statement Section revised, replaced non-covered verbiage with "not medically necessary"

12/28/2009: Policy Guidelines section was revised to remove definition of an investigative service.

07/30/2015: Code Reference section updated for ICD-10.

  

SOURCES

Centers for Medicare & Medicaid Services (CMS)

 

CODE REFERENCE

This may not be a comprehensive list of procedure codes applicable to this policy.

Not Medically Necessary Codes

Code Number

Description

CPT-4

80050

General Health Panel

HCPCS

  

ICD-9 Procedure

ICD-10 Procedure

  

 

 

ICD-9 Diagnosis

ICD-10 Diagnosis

  

 

 

 

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