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    v1.0.30
    OpenPayerBilling CodesOrgan or Disease Oriented PanelsCPT cpt-80055-obstetric-panel-prenatal-lab-testing
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    CPT 80055: Obstetric Laboratory Panel

    Commercial payers pay $68 on average nationally for this procedure.

    CPT code 80055 describes an obstetric laboratory panel performed by a laboratory analyst that includes a complete blood count with differential, hepatitis B surface antigen, rubella antibody, qualitative non-treponemal syphilis test, red blood cell antibody screen, ABO blood typing, and Rh typing; the service type is a comprehensive prenatal infectious disease and blood-typing screening panel typically performed in an outpatient laboratory or hospital clinical laboratory setting and ordered as part of routine prenatal care.

    For related coverage guidance, see recent payer policy updates: Long-Acting Injectable Antiretroviral Agents for HIV, B-Hemolytic Streptococcus Testing, Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance Assays.

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    National Reimbursement Benchmarks

    BUCA’s average commercial rate for CPT 80055 sits at $68.30, positioning it near the middle of the payer mix. Blue Cross Blue Shield shows the highest dispersion with a P75–P25 range of $43.95 ($108.40 − $64.50), indicating a wide distribution of contracted rates. Cigna’s interquartile spread is $39.0 ($66.00 − $27.10), while Aetna’s spread is $13.00 ($45.00 − $31.00). UnitedHealth Group is the tightest among the listed payers with a P75–P25 range of $27.80 ($47.80 − $21.00), suggesting more consistency across commercial contracts for this code.

    Looking at central tendency, Blue Cross Blue Shield and Cigna have higher mean and median positions relative to BUCA’s average, while Aetna and UnitedHealth Group report lower central values. Extreme maximums are notable for Blue Cross Blue Shield ($264.50) and Cigna ($159.00), which widen potential upside compared with BUCA’s average of $68.30. The combined picture is one of moderate central clustering around BUCA with pockets of significant upward variability driven primarily by Blue Cross Blue Shield and Cigna.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A pregnant patient presents for routine prenatal laboratory evaluation at an outpatient obstetrics clinic or hospital-based prenatal testing laboratory. The clinic nurse draws blood during the initial prenatal visit (typically first trimester) or at a prenatal screening visit. The laboratory performs an obstetric panel that includes a complete blood count with differential for anemia and infection assessment, hepatitis B surface antigen to assess maternal infectivity, rubella IgG antibody to determine immunity status, a qualitative non-treponemal syphilis test for screening (e.g., RPR or VDRL), a red blood cell antibody screen to detect alloimmunization, ABO blood grouping, and Rh (D) typing to determine Rh incompatibility risk. Results are routed to the ordering obstetric provider (OB/GYN, maternal-fetal medicine specialist, or family medicine clinician) for interpretation and incorporation into the prenatal care plan. Typical sites of service are outpatient physician offices, ambulatory clinics, hospital outpatient departments, and clinical reference laboratories. The service type is a prenatal obstetric laboratory panel billed under a single-panel CPT code for bundled testing performed by the laboratory analyst.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    80047Basic metabolic panel (BMP)May be ordered concurrently for baseline metabolic assessment during pregnancy.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    90Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
    91Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207Q00000X
    207L00000X
    208D00000X
    207X00000X
    133VN1006X
    2471C1106X
    251T00000X
    156FX1100X

    Related Payer Policy Updates

    Specialty: Infectious Disease1 / 3

    10 rows

    PolicyPayerEffective Date
    Long-Acting Injectable Antiretroviral Agents for HIVColorado Rocky Mountain Health Plans2026-10-01
    B-Hemolytic Streptococcus TestingOscar Health2026-10-01
    Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance AssaysOscar Health2026-10-01
    Hepatitis Testing (A, B, C, D) Coverage CriteriaOscar Health2026-10-01
    Lyme Disease Testing Coverage CriteriaOscar Health2026-10-01
    Pathogen Panel TestingOscar Health2026-10-01
    Diagnostic Testing of Common Sexually Transmitted InfectionsOscar Health2026-10-01
    Coronavirus Testing in the Outpatient SettingOscar Health2026-10-01
    Testing for Vector-Borne InfectionsOscar Health2026-10-01
    Testing for Diagnosis of Active or Latent TuberculosisOscar Health2026-10-01

    Related Codes

    CPT-80047-BASIC-METABOLIC-PANEL-BMP

    CPT 80047: Basic Metabolic Panel (BMP)

    CPT-80048-BASIC-METABOLIC-PANEL-BMP

    CPT 80048: Basic Metabolic Panel (BMP)

    CPT-80050-GENERAL-HEALTH-PANEL-SCREENING-LAB

    CPT 80050: General Health Panel Screening

    CPT-80051-ELECTROLYTE-PANEL-NA-CL-K-CLO-CO2

    CPT 80051: Electrolyte Panel (Na, K, Cl, CO2)

    CPT-80053-COMPREHENSIVE-METABOLIC-PANEL-CMP

    CPT 80053: Comprehensive Metabolic Panel (CMP)

    CPT-80061-LIPID-PANEL-CHOLESTEROL-TRIGLYCERIDES

    CPT 80061: Lipid Panel (Cholesterol and Triglycerides)

    CPT-80069-RENAL-FUNCTION-PANEL-LAB-TEST

    CPT 80069: Renal Function Panel, Blood

    CPT-80074-ACUTE-HEPATITIS-PANEL-SEROLOGY

    CPT 80074: Acute Hepatitis Serology Panel

    CPT-80076-HEPATIC-FUNCTION-PANEL-LIVER-CHEMISTRY

    CPT 80076: Hepatic Function Panel (Liver Chemistry Tests)

    CPT-80081-OBSTETRIC-PANEL-INITIAL-PRENATAL-TESTING

    CPT 80081: Obstetric Screening Panel for Prenatal Care

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    83036
    Hemoglobin; glycosylated (A1c)
    Ordered if there is concern for pregestational or gestational diabetes requiring baseline glycemic assessment.
    86704Rubella antibody, IgGSpecific component test for rubella immunity; may be individually ordered or included in the panel.
    87661Hepatitis B virus, DNA; quantificationFollow-up molecular testing when hepatitis B surface antigen is positive for maternal infectivity assessment.
    86850Blood typing; ABOComponent test that is part of the obstetric panel or can be ordered separately for transfusion planning.
    86900Rh (D) typingComponent test for Rh status; used to determine need for Rh immune globulin prophylaxis.