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Printer Friendly Version General Health Panel

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.

SOURCES

Centers for Medicare & Medicaid Services (CMS)

CODE REFERENCE

All codes billed are considered non-covered and not eligible for coverage.

Non-Covered Codes

Code Number	Description
CPT
80050	General Health Panel
ICD-9 Procedure

ICD-9 Diagnosis



HCPCS

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