How Much Should A Basic Metabolic Panel Cost?

After waiting for 78 days, I will finally get in to see my new doctor later in October. During this free annual exam, he will likely order a basic metabolic panel. I sometimes hear it called BMP for short. I’ve personally had this ordered for me during other physicals and have seen it ordered routinely at clinics I have worked with in the past. But what is a basic metabolic panel and how much should it cost?

That’s right, we’re going to get scientific here today at Max Out of Pocket. Don’t worry, I think you can handle it.

It is a good idea to always be prepared for other things that might be ordered by a doctor during an annual exam. That way, we can prevent unexpected medical bills for out-of-pocket costs. If you haven’t figured it out yet, Max doesn’t like surprises. But I am always willing to take one for the team and put myself at risk for some extra out-of-pocket costs so others can benefit and learn from this process.

I already know I am going to get a free lipid panel (cholesterol test) ordered during this exam, but what else should I expect? Today, we are going to dive into the basic metabolic panel.

A laboratory waiting room. A basic metabolic panel might happen at place like this.

What Is A Basic Metabolic Panel?

I like labs because my doctor and I get to see what is going on inside my body. The basic metabolic panel looks at a wide range of blood chemicals to make sure nothing is imbalanced. Just like my free lipid panel, this lab test measures more than one indicator. The results will give my doctor some information about how my metabolism is functioning. This includes the health of my kidneys, blood glucose levels, and electrolytes. 

For all my coding friends out there, the basic metabolic panel (BMP) is often referred to as CPT 80048. That is how it is reported on the claim form to the insurance company.

What does it measure?

Specifically, this lab test measures these eight indicators and compares them to the normal ranges for other humans just like me.

  • Calcium
  • Carbon Dioxide
  • Chloride
  • Creatinine
  • Glucose
  • Potassium
  • Sodium
  • Urea Nitrogen

Wow. Eight tests in one, I like this deal already.

Max will be the first to say, I am not a doctor and I have absolutely no idea what half of these blood chemicals are. But I am happy to have my medical provider evaluate where I stand in comparison to normal ranges.

In my case, I will take my lab order over to the hospital lab and they will start by drawing my blood. They will then put it into some fancy instrumentation that will spit out a report with my individual levels on all the components listed above. The report will even provide the normal reference ranges to help me and my doctor easily identify anything that looks out of sync. You can find out a little more about this test at labtestsonline.org.

Lab equipment we might see something like a basic metabolic panel done on.
This is officially the first stock image for the Max Out of Pocket blog. End of an era, but I got it free at www.pexels.com.

I think if we went back a few hundred years and told people that in the future we would be able to screen blood to help identify disorders, it would blow their minds. They might even wait in line to have this test done. Nowadays, people yell and throw fits because the lab is running behind and they have to wait an extra 15 minutes to have their blood drawn. Hedonic adaptation at its best. Have we lost touch with where we are with healthcare? But I digress…

How Much Should A Basic Metabolic Panel Cost?

If I get a basic metabolic panel lab test after my clinic visit in October, it will have a retail “out-the-door price” of about $85 at my local hospital. In my experience, this is on the low end of the pricing spectrum for a basic metabolic panel in this setting. 

Max OOP’s 2019 out-the-door price for basic metabolic panel = $85

I have personally seen hospital charges that range between $70 and $250 for this test. Another hospital an hour from me charges about $151 for the exact same test I am getting for only $85. That $66 difference might just cover the time and gas for someone to drive across town to get a cheaper test. The 50th percentile of hospitals would charge about $140 for the BMP.

Again, this is where we need to let price transparency and competition do its thing to help get things normalized.

Now, if I were to have this drawn in a clinic and have them send it off to a reference lab for processing, it is likely to come in at a much lower price. I would say $30 – $60 would be a more reasonable price in a lower-cost setting. I am making a conscious decision to have mine done in a hospital.

How Much Will My Insurance Pay For a Basic Metabolic Panel?

I happen to already know that my insurance has negotiated the hospital’s price for this test down to $61.76. In other words, they won’t pay the full $85 retail price; they will get the test on sale for only $61.76. Everyone’s insurance rate will be different, and it is always a good idea to get these rates before having a test like this.

How Much Will I have To Pay?

This is where I get to reiterate that every insurance plan is different. Just like the sale price for the BMP is different from insurance to insurance, so are the out-of-pocket costs. So, make sure you understand your benefit package. Since I am on a high deductible plan, I have to assume that this test would hit my deductible and I would have to pay the full $61.76.

In reality, my provider will likely order the BMP with the following diagnosis code:

Z00.00 (Encounter for general adult medical examination without abnormal findings)

After all, I am a perfectly healthy individual and we are only using this test to screen for possible issues. I believe the Z00.00 code will trigger my insurance to waive my deductible and pay the full $61.76 on my behalf.

Technically, they have no legal obligation to pay this test in full and they could let it hit my deductible. But, I have seen it covered in the past as a preventative preventive benefit and paid out in full with no out-of-pocket cost to me. The verdict is still out for 2019 and I will keep everyone posted on how it pans out.

How Much Would Medicare Pay For A Basic Metabolic Panel?

I like to throw out the Medicare price here just to get people fired up. They might also choose to use the rate for negotiation tactics with a hospital or reference lab. As I like to say, Medicare has more pricing power than Walmart. In 2019, Medicare is paying most non-rural hospitals $9.40 for the basic metabolic panel.

You can download this information here.

Medicare price for a basic metabolic panel
Medicare typically only pays $9.40 for a basic metabolic panel.

There’s that ‘problem gap’ again. I mentioned it briefly when we looked at the price for a hernia repair surgery last month. My insurance is paying $50.71 more than Medicare pays most for the exact same test. A ‘Medicare For All’ scenario would need to address this ‘problem gap’ or we are going to see some serious financial problems across the industry.

$61.76 (my price) – $9.40 (Medicare’s price) = $52.36 (problem gap)

Final Thoughts

Max OOP clearly does his research before consuming elective healthcare services. Since it is reasonable to think a basic metabolic panel is something I might see ordered during my annual preventive exam, it is worth getting it priced out to help me manage out-of-pocket costs. I need to know both the retail price and the sale price my insurance gets it for. Since the Affordable Care Act does not mandate coverage for this test, I also need to be ready for this test to hit my deductible.

Max Out of Pocket for my basic metabolic panel (BMP) = $61.76

Do you have a metabolic panel ordered annually?

*This is not a recommendation to get or not get a basic metabolic panel. That decision can only be made by you and your doctor. The content of this article is based on my experience and my own opinions.

Share

7 Responses

  1. I don’t think I do have a metabolic panel ordered each year, but I honestly don’t remember. I get blood drawn for other tests, so I don’t keep track of when I got which test. I knew that Medicare did a number on what it’s willing to pay providers/hospitals, but $9.40? Ouch. On the other hand, hospitals had a hand in negotiating this price — that is, they had to accept it — so it may be that the regular price is just super inflated. After all, the machines cost a ton of money, but amortized over the number of tests they run, it’s probably less than $9.40 per test. So there’s that.

    • Max OOP says:

      Hi Abigail! Good questions about the pricing. There is a lot of cross-subsidizing going on (particularly in hospitals) where they are using on service to offset the cost for another service. Medicare usually pays at or a little under cost, so you are probably right that the true cost of the BMP is closer to $10. You should ask your provider the next time about your BMP and see what they think!

      Max

  2. What are your thoughts on telling a providor I dont have insurance to get the cheaper Self-pay price for a medical service? Since I have a high deductible plan, I’m planning on using this method, but the doctor’s referal not for the lab order has my insurance info. You think I can black it out, or request a new order without the insurance info?
    Great post btw

    • Max OOP says:

      I love this question. I used to think this was in the gray area, but now I definitely think it is fair game considering how broken the system is. Some hospitals or providers may say it is against their policy, but I would ask to see the policy. That said, you will want to know both rates (your insurance discount and uninsured discount). I am on a high deductible plan as well, and the hospital I will have the services at has an uninsured adjustment of 33% which will get this test down to $56.95 (this is $4.81 cheaper than my insurance negotiated rate that would hit my deductible). But it won’t always work to your advantage. Also, a few insurance plans (including mine) will cover the BMP as preventive with that Z00.00 code I referenced, so you would essentially be paying for a test you could get for free. Clear as mud?

      I don’t think it would be out of line to ask for a referral without your insurance, but a lot of these billing systems talk to each other so it might not prevent them from seeing it. It may be easier to just negotiate them down to the self-pay rate but I would stay as professional as possible about it since that seems to work much better than the “angry red face” method.

      Thanks – I will talk more about the uninsured discount soon. Are you having just the BMP or other tests as well?

      Max

      • Gabriel says:

        It’s actually a 20 week sonogram cpt 76805 for my wife. Self pay without insurance is around 150 and the insurance negotiated rate is 665. So it’s a huge difference. And we are no where close to hitting the 3k insurance deductible by the end of the year, so getting the lower selfpay rate is a must!

        • Max OOP says:

          Sounds like a congratulations is in order! Good luck with everything.

          Interesting, are you having it done in the hospital setting or at a clinic? I would lobby hard for that $150 rate if you can get it. You could try and meet them halfway at $300? Nice foresight keeping the calendar year-end in mind and the deductible re-set. Please let me know how it goes, could make a good case study. You will want to talk to their “revenue cycle director” or “patient financial services director” if possible.

          You are getting a better deal than I am. My insurance has negotiated this service (76805) down to $740 in the hospital and it would all hit my deductible (New England market). There would be a “read” fee on top of that for the radiologist to read it. What regional market are you in?

          Medicare wouldn’t pay for many of these since most of its beneficiaries aren’t child-rearing age, but their national payment rate is about $112 in the hospital. They would come in slightly higher in a high cost of living area. The radiologist read would come in at about $50. There is no reason for you to be paying over 4 times that.

          Congrats! Max.

          These are all estimates only but I can provide you the Medicare sources if you need it!

          Max

          • Gabriel says:

            Thanks!
            I’m in the DMV area. Those rates are for a clinic, since hospitals would be pricier. I completely forgot about the radiology reading fee. I’ll probably get charged an office visit too.

            I’ll update on what happens… don’t want to think it over too much amd stress out!

Leave a Reply

Your email address will not be published. Required fields are marked *