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CPT 80055: Obstetric Panel for Prenatal Laboratory Evaluation
CPT code 80055 designates a comprehensive obstetric laboratory panel used in prenatal evaluation. The panel bundles several essential tests—complete blood count with differential, hepatitis B surface antigen, rubella antibody, qualitative non-treponemal syphilis test, red blood cell antibody screen, ABO typing, and Rh typing—integral to assessing maternal and fetal risk early in pregnancy. Nationally, this panel is a standard component of prenatal care and influences clinical management, transfusion planning, and public health screening efforts.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an overview of how the service is defined clinically, typical sites of service, and the components that constitute the bundled panel. The publication also summarizes payer coverage considerations, coding practice implications, common associated modifiers, and benchmarking context where available. Policy updates relevant to laboratory bundling and prenatal screening are addressed to inform coding accuracy and payer interactions.
This summary provides clinicians, billing professionals, and policy analysts a concise reference to the clinical scope of CPT code 80055, the tests it encompasses, and the payer landscape relevant to national prenatal laboratory services. Data not available in the input is noted where applicable in the full publication.
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Billing Code Overview
CPT code 80055 describes an obstetric panel performed by a laboratory analyst. The panel must include 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.
Service Type: Laboratory testing for prenatal/obstetric evaluation
Typical Site of Service: Clinical laboratory or hospital outpatient laboratory
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.