In the realm of pathology and laboratory billing, the use of incorrect or outdated lab CPT codes is a leading factor contributing to claim denials. Are your lab test claims facing delays or denials even after adhering to the specified reasons? The Office of Inspector General (OIG) reports that over 29% of laboratory claims submitted to Medicare in 2023 contained coding inaccuracies, primarily due to the improper application of CPT codes or inadequate documentation. Such errors can lead to payment delays, compliance audits, or recoupments, adversely affecting the cash flow for providers and billing teams.
In 2025, the CPT update will introduce 270 new codes, eliminate 112 codes, and modify 38 codes, with laboratory and genetic testing codes representing roughly 37% of all new additions. This is a direct response to the increasing complexity of diagnostics and molecular testing. Practices that neglect to revise their charge masters and billing protocols may end up submitting incorrect claims. For instance, CMS estimated that the use of outdated CPT codes resulted in over $13 million in erroneous laboratory payments in 2024 alone.
This blog aims to guide the essential Lab CPT Codes for 2025, covering organ panels, molecular pathology, genomic sequencing, and proprietary lab analysis. You will gain insights on how to utilize these codes accurately, avoid common billing mistakes, and ensure compliance with CMS, AMA, and payer standards. Whether you are a biller, programmer, or supplier, this article equips you with the necessary information to prevent rejections and sustain your revenue.
Lab CPT Codes: 2025 Overview
Each year, laboratory CPT codes undergo modifications to align with advancements in clinical practice, Medicare policies, and testing methodologies. In this section, we will outline the current definitions of Lab CPT Codes along with the significant revisions that have been finalized for 2025.
What Are Lab CPT Codes?
These codes detail the diagnostic tests performed, including blood counts, metabolic panels, and genetic assessments.
There are four primary categories:
- Routine chemistry codes (e.g., 80048, 80053)
- Molecular pathology and genetic testing codes (e.g., 81203–81479)
- Proprietary Laboratory Analyses (PLA) codes (e.g., 0250U–0411U)
2025 Code Highlights
As reported by the American Medical Association, the 2025 Laboratory Billing CPT Codes will include 270 new codes, 112 codes that will be removed, and 38 modifications. Significantly, 37% of the new codes facilitate private genetic testing.
Key additions for 2025 include:
- G0567: Hepatitis C screening using an amplified probe
- 81195–81210: Enhanced NTRK, EGFR, JAK2, and KRAS gene testing
Codes that have been deleted pertain to analyte techniques that are no longer in use. Changes have been made to test descriptions and reporting language, particularly in the areas of remote monitoring and AI-assisted diagnosis.
CPT Codes for Laboratory Tests: By Category
Lab CPT Codes are classified according to their purpose and the type of specimen involved. Below are the primary code categories that are most commonly utilized in outpatient, inpatient, and specialized practices.
Chemistry & Panels
These CPT codes pertain to frequently requested laboratory tests that assess metabolic, liver, kidney, and endocrine functions. Panels consolidate several tests into a single billing code.
| CPT Code |
Description |
Key Use |
| 80048 |
Basic Metabolic Panel (Calcium, total) |
Evaluates electrolytes, kidney function |
| 80053 |
Comprehensive Metabolic Panel |
Assesses liver, kidney, glucose, and more |
| 80076 |
Hepatic Function Panel |
Checks liver enzymes and bilirubin |
| 84443 |
Thyroid Stimulating Hormone (TSH) |
Screens for thyroid disorders |
| 82306 |
Vitamin D, 25-hydroxy |
Evaluates bone health, deficiencies |
| 84153 |
Prostate-Specific Antigen (PSA), total |
Prostate cancer screening |
| 82247 |
Bilirubin, total |
Liver and gallbladder function |
| 83735 |
Magnesium |
Electrolyte monitoring |
Hematology & Coagulation
These CPT codes encompass tests for blood counts, clotting factors, and evaluations for anemia.
| CPT Code |
Description |
Key Use |
| 85025 |
Complete Blood Count (CBC) with automated differential |
Evaluates red/white cells, hemoglobin, and platelets |
| 85027 |
CBC without differential |
Basic blood profile without WBC breakdown |
| 85007 |
Blood smear, microscopic examination |
Assesses abnormal cells manually |
| 85730 |
Partial Thromboplastin Time (PTT) |
Monitors heparin test, bleeding disorders |
| 85610 |
Prothrombin Time (PT) |
Evaluates clotting time; warfarin monitoring |
| 85210 |
Fibrinogen level |
Screens for coagulation issues |
| 85652 |
Sedimentation rate, non-automated |
Detects inflammation |
| 86038 |
Platelet antibody detection |
Assesses platelet-related immune response |
Urinalysis & Drug Testing
These CPT codes encompass standard urinalysis, drug detection, and screening panels. Precise code selection is essential for reimbursement and medical justification.
| CPT Code |
Description |
Key Use |
| 81001 |
Urinalysis, automated with microscopy |
Assesses urinary tract infections or kidney problems |
| 81003 |
Urinalysis, automated without microscopy |
Common for routine health assessments |
| 82043 |
Microalbumin, quantitative |
Identifies early kidney damage |
| 82570 |
Creatinine; other sources than serum |
Validates urine dilution or renal function |
| 80305 |
Drug test, presumptive, any number of drug classes |
Quick screening using an immunoassay |
| 80306 |
Drug test, instrumented chemistry analyzer |
Instrument-based testing is more dependable |
| 80307 |
Drug test, definitive by instrument, e.g., LC-MS/MS |
Comprehensive substance identification |
Microbiology & Infectious Tests
These CPT codes pertain to diagnostic tests for bacterial, viral, and fungal infections. Accurate documentation guarantees that billing is precise and complies with payer requirements.
| CPT Code |
Description |
Key Use |
| 87070 |
Culture, bacterial; any source, except urine, blood |
Identifies bacterial organisms in clinical specimens |
| 87086 |
Urine culture, quantitative |
Confirms urinary tract infections (UTIs) |
| 87186 |
Antibiotic susceptibility test, quantitative |
Establishes the resistance patterns of bacteria |
| 87635 |
COVID-19 testing, amplified probe technique |
Identifies the SARS-CoV-2 virus |
| 87804 |
Influenza virus detection by immunoassay |
Rapid testing for influenza |
| 87426 |
SARS-CoV-2 antigen testing, immunoassay |
Point-of-care antigen test for COVID-19 |
Molecular Pathology & Genetic Testing
Precise coding is essential for funding complex tests and ensuring compliance with payment regulations.
| CPT Code |
Description |
Key Use |
| 81220 |
CFTR gene analysis, common variants |
Cystic fibrosis screening |
| 81225 |
NPM1 gene analysis, common variants |
Leukemia mutation testing |
| 81241 |
The TP53 gene is recognized for familial variant analysis |
Cancer risk assessment |
| 81245 |
F5 (Leiden) gene mutation analysis |
Thrombophilia testing |
| 81275 |
HLA-DQB1 typing |
Transplant compatibility |
| 81295 |
MSH2 gene full sequencing |
Lynch syndrome detection |
| 81301 |
PMS2 gene full sequencing |
Hereditary cancer testing |
Laboratory Billing CPT Codes 2025: Rules & Avoiding Denials
In 2025, Medicare and commercial payers will evaluate your lab claim based on the four critical categories outlined below.
Modifier Use for Laboratory CPT Codes 2025
Inappropriate modifier application is a primary reason for laboratory billing denials.
| Modifier |
Description |
Use Case |
| -91 |
Repeat the clinical diagnostic laboratory test |
Utilized when the same test is conducted again on the same day for monitoring purposes. |
| -59 |
Distinct procedural service |
Implemented when lab services are separate and not included in a panel |
| -76 |
Repeat the procedure by the same provider |
Employed when the same test is performed again by the same provider on the same day. |
| -77 |
Repeat the procedure by another provider |
When a laboratory test is repeated by a different provider. |
Medical Necessity & Documentation
Medical requirements must be explicitly detailed in the documentation that supports each CPT code for laboratory testing.
- A licensed practitioner is required to order the test for diagnostic or therapeutic purposes.
- Include the precise diagnosis (ICD-10 code) that aligns with the requested test.
- Ensure that the documentation specifies how the test affects treatment or outcomes.
- Frequent rejections happen when screening diagnostic codes are applied to non-screening tests.
MUE and UOS Limits
Medically Unlikely Edits (MUEs) and Units of Service (UOS) restrictions limit the number of tests that can be billed each day of service.
- CMS publishes MUEs to identify billing problems and overutilization.
- Do not split tests over multiple days to circumvent MUEs; this could result in fraud issues.
Fee Schedule & Payment Changes
Understand the modifications in payment rates and laboratory billing regulations for 2025.
- The April 2025 CLFS update added and removed CPT codes for proprietary and genetic testing.
- New codes, such as G0567 for Hepatitis C screening, have been established and will be priced by MAC until CMS assigns national values.
- Payment cuts for non-ADLTs will commence in 2026, with a new annual cap of 15%.
Conclusion
Keeping abreast of the 2025 Lab CPT Codes is essential for accurate billing, appropriate reimbursement, and adherence to payer requirements. The improper use of codes and modifiers continues to be a significant reason for claim rejections. Documentation must indicate medical necessity and coding accuracy. With frequent updates from CMS and AMA, reliance on outdated practices could result in financial losses.
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