Summary & Overview
CPT 82040: Quantitative Albumin Measurement in Serum, Plasma, or Whole Blood
CPT code 82040 represents the quantitative measurement of albumin in serum, plasma, or whole blood, a key laboratory test in clinical chemistry. Albumin levels are essential indicators for evaluating liver and kidney function, nutritional status, and various chronic conditions. This procedure is widely performed in laboratory settings and is a standard component of many diagnostic panels.
Major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare provide coverage for this test, reflecting its clinical importance and broad utilization across healthcare systems. The publication offers a comprehensive overview of payer coverage, clinical context, and relevant billing considerations for CPT code 82040. Readers will gain insights into typical sites of service, common modifiers used in billing, associated provider taxonomies, and ICD-10 diagnoses frequently linked to albumin testing. Additionally, the summary highlights related CPT codes, such as hepatic function panels, to provide context for how albumin measurement fits within broader laboratory testing protocols.
This article is designed to inform healthcare professionals, laboratory administrators, and policy analysts about the national landscape for albumin testing, including payer policies, clinical relevance, and coding practices. Benchmarks and policy updates are included to support understanding of current trends and requirements in laboratory billing and reimbursement.
CPT Code Overview
CPT code 82040 is used to report the quantitative measurement of albumin in serum, plasma, or whole blood. Albumin testing is a fundamental chemistry procedure performed in clinical laboratories to assess protein levels, which are critical for evaluating liver and kidney function, nutritional status, and overall health. The typical site of service for this procedure is a laboratory setting, often designated as Place of Service 81 (independent laboratory) or 11 (office-based collection). This test is commonly ordered as part of routine panels or for targeted clinical assessments.
Clinical & Coding Specifications
Clinical Context
A patient presents to a primary care clinic or is admitted to a hospital with symptoms suggestive of liver or kidney dysfunction, such as edema, fatigue, or abnormal laboratory findings. The provider orders a quantitative albumin test (82040) to assess the patient's serum, plasma, or whole blood albumin levels. The specimen is collected in the office (Place of Service 11) or sent to a clinical laboratory (Place of Service 81) for analysis. The results help guide diagnosis and management of conditions like hypoalbuminemia, chronic kidney disease, or liver disease. Repeat testing may be performed to monitor disease progression or response to treatment.
Coding Specifications
-
Modifier
91: Used when the albumin test (82040) is repeated on the same patient to monitor changes over time, such as during ongoing treatment or disease monitoring. -
Modifier
59: Applied when the albumin test is performed as a distinct procedural service, separate from other laboratory tests, to indicate that it is not part of a bundled panel.
| Provider Taxonomy Code | Specialty |
|---|---|
291U00000X | Clinical Medical Laboratory |
207Q00000X | Family Medicine Physician |
207R00000X | Internal Medicine Physician |
Related Diagnoses
-
E87.6: Hypoalbuminemia
Relevant for patients with low albumin levels, which may indicate malnutrition, chronic illness, or protein loss. -
R74.0: Nonspecific elevation of levels of transaminase and lactic acid dehydrogenase [LDH]
Used when abnormal liver enzyme levels are detected, often prompting albumin testing to further assess liver function. -
N18.9: Chronic kidney disease, unspecified
Albumin levels are monitored in kidney disease to evaluate protein loss and disease progression. -
K76.9: Liver disease, unspecified
Albumin testing is essential in evaluating liver function and detecting hepatic dysfunction. -
R79.89: Other specified abnormal findings of blood chemistry
Applied when abnormal blood chemistry results are found, including abnormal albumin levels, requiring further investigation.
Related CPT Codes
80076: Hepatic function panel (includes Albumin82040, Bilirubin total82247, Bilirubin direct82248, Alkaline phosphatase84075, Protein total84155, ALT84460, AST84450)
The hepatic function panel (80076) includes the albumin test (82040) as one of its components. In clinical workflows, 80076 is commonly ordered when a comprehensive assessment of liver function is needed. The albumin test (82040) may be ordered separately when only albumin measurement is required, or as part of the panel when broader liver function evaluation is indicated. These codes are often used together, but not simultaneously billed if the panel is ordered.
National Reimbursement Benchmarks
National mean rates for CPT code 82040 show that commercial payers, represented by BUCA, average $5.90, while Medicare rates are not available in the input. Among individual commercial payers, Cigna has the highest mean rate at $7.60, and UnitedHealth Group has the lowest at $4.23.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Cigna exhibits the widest spread ($3.50), indicating greater variability in reimbursement, while Blue Cross Blue Shield and BUCA have tighter ranges ($2.17 and $2.60, respectively). UnitedHealth Group shows the narrowest dispersion at $2.67.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
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