As you might have already figured out, Max likes to be extremely comprehensive when planning for out-of-pocket healthcare costs. But I also like to be just as comprehensive with my actual healthcare. So when my doctor offered to order me a comprehensive metabolic panel at my free preventive exam last week, I just about fell off the exam table in excitement.
I figured why not throw down an extra $15.38 and spring for a more comprehensive look at my blood chemicals. Little did my doctor know, I already priced this particular test out before he even ordered it. I suspected he might take this approach with my annual labs. As they say, go big or go home. I get six more levels measured with this test and a closer look at how my liver is functioning. Since I like to throw back a little too much Canadian Moosehead from time to time, it might not hurt to check in on that organ.
We learned a few weeks ago about the basic metabolic panel and how much it might cost. Today, we will take a look at the comprehensive metabolic panel. I often hear it called CMP for short. This is another lab test that might be ordered during a preventive physical exam.
This falls under CPT code 80053 for all you coding experts out there.
What Is A Comprehensive Metabolic Panel?
A comprehensive metabolic panel is a lot like the basic metabolic panel. It just has a few more tests in it. Instead of looking at 8 blood chemicals we get to look at 14. I bolded the additional chemical levels we get to measure with this panel below.
- Carbon Dioxide
- Transferase (ALT)
- Transferase (AST)
- Urea Nitrogen
Wow. Talk about comprehensive.
Just like the basic metabolic panel, this test checks the status of a person’s metabolism. This includes the health of the kidneys, blood glucose levels, and electrolytes. But the CMP goes beyond that. It checks in on liver function, and the liver is a pretty important organ.
Although it is a pretty detailed test, it does have its limitations and can sometimes produce false positives on some of the indicators causing additional testing we may or may not need. I am willing to take that risk, but it is definitely worth reviewing these options with your doctor.
The hospital lab will take my blood and use special instrumentation to get my levels on all the indicators above. It even spits out the normal reference ranges to help me and my doctor easily identify if anything looks out of sync. You can learn a little more about this test at labtestsonline.org. I have no affiliation with them.
How Much Should It Cost?
Price-wise, my comprehensive metabolic panel will come in a little higher than the basic version. That makes sense considering we are getting six more tests added to the panel. The retail price for the CMP is about $108 at the hospital I go to. This is $23 more than I would be charged for the basic version of the metabolic panel. That’s about $3.83 for each additional blood chemical.
I have personally seen charges for this test range between $90 and $275 at hospitals. The 50th percentile price for the CMP would come in at about $190. A hospital I priced about an hour from me charges $185 for the exact same lab test I get for $108 at my local hospital.
Now if we have this drawn in a clinic and done by a reference lab, it is likely to come in at a much lower price. I would say $35 – $65 would be more reasonable in a lower-cost setting. If you have any examples of this you are willing to share, please do so in the comments below along with your geographical region.
How Much Will My Insurance Pay?
You might remember, I priced out the basic metabolic panel through my insurance and they negotiated the price down to $61.76 when done at my local hospital. I like to compare the negotiated price to the sale price you might see at T.J. Maxx.
So I also priced the CMP out with my insurance. This test comes in $15.38 higher with a negotiated rate of $77.14 when it is done in the hospital I go to. In other words, they won’t pay the full $108 retail price; they will get the test on sale for $77.14. It is always a good idea to ask for these insurance rates before having the test.
Here is a side by side look at the BMP and CMP pricing where I get services and the negotiated rate my insurance gets to pay. This is obviously a sample size of one and pricing for only my market.
How Much Will I Have To Pay?
This is where I get to say every insurance plan is different, and make sure you understand your benefits package. Since I am on a High Deductible Health Plan (HDHP), I would have to assume that this test would hit my deductible. In that case, I would have to pay the full $77.14 my insurance company negotiated this test down to.
In reality, my doctor ordered this with the Z00.00 (Encounter for general adult medical examination without abnormal findings) diagnosis code. I talked about this code when we covered the free cholesterol screening. This code triggers the insurance company to waive my deductible and pay
preventative preventive services in full. So in this case, they will likely pay the $77.14 on my behalf even though they technically have no legal obligation to do so. It doesn’t work for all lab tests, but I believe my insurance considers this particular test preventive in nature. We will verify this when the claim processes.
How Much Would Medicare Pay?
I like to throw the Medicare payment amount here just to expose the gap in reimbursement. I like to say Medicare has more pricing power than Walmart. In 2019, Medicare is paying most non-rural hospitals $11.74 for the comprehensive metabolic panel. You can download this information here.
There is that “problem gap” again, we just keep seeing this trend here at Max Out of Pocket.
$77.14 (my negotiated rate) – $11.74 (Medicare rate) = $63.34 (problem gap)
The decision to have this test done is between the patient and the medical provider. If it happens to hit my deductible, I am willing to shell out the $77.14 to have this panel of 14 tests done. It is worth the money to me to make sure my levels for these blood chemicals are within normal ranges. Will I have it every year? Maybe, maybe not.
My max out-of-pocket for a comprehensive metabolic panel in 2019? About $77.14, unless my insurance pays this in full.
*This is not a recommendation to get or not get a comprehensive 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.