Laboratory Panels and Other Lab Services
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Defines Florida Blue's reimbursement methodology for organ- and disease-oriented laboratory panels and their individual component tests, plus rules for date of service, repeat services, and place of service; applies to all lines of business and providers billing on CMS-1500 or equivalent.
Respiratory viral panel (87631) and infectious agent panels (87800 and 87801) and their corresponding components were added to the policy and will be used for reimbursement when three or more individual tests are billed by the same provider on the same date of service effective 07/01/2026.
Panel Reimbursement and Billing Criteria
Reimbursement and billing criteria
Florida Blue will bundle and reimburse laboratory panels according to the following criteria.
OR
- When the combined reimbursement for the individual component codes exceeds the reimbursement for the comprehensive panel code, Florida Blue will bundle the components into the appropriate comprehensive panel code for payment.
- Florida Blue considers an individual component code included in the reimbursement for the comprehensive panel code when reported on the same date of service by the same provider.
Representative Panel and Component Codes
| 87631 | Respiratory virus panel; includes multiplex reverse transcription and multiplex amplified probe technique, multiple types/subtypes, 3-5 targets |
| 87800 | Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique |
| 87801 | Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique |
| 80053 | General health panel = Comprehensive metabolic panel |
| 82040 | Albumin (component of hepatic/renal panels) |
Billing, Repeat Testing, and Operational Rules
Billing, bundling, and repeat-test rules for panels
When all individual procedures of a panel are billed by the same provider on the same date, Florida Blue will bundle the components and reimburse based on the appropriate comprehensive panel code. Effective 07/01/2026, when three or more individual tests corresponding to respiratory viral panel (87631) or infectious agent panels (87800, 87801) are billed by the same provider on the same date, payment will be made based on the panel code and limited to one unit of the panel code regardless of units billed for individual tests. The date of service is the specimen collection date; modifier 91 is appropriate for medically necessary same-day repeat testing, whereas modifiers 76/77 are inappropriate for repeat laboratory services.
- Bundle components and reimburse at the comprehensive panel code when all individual component procedures of the panel are billed by the same provider on the same date.
- If combined payment for individual component codes would exceed the panel reimbursement, Florida Blue will bundle into the panel code for payment.
- Effective 07/01/2026: when 3+ individual tests corresponding to 87631, 87800, or 87801 are billed by the same provider on the same date, pay one unit of the panel code regardless of individual test units billed.
- Date of service for laboratory tests = specimen collection date.
- Use modifier 91 for clinically necessary same-day repeat testing; do not use modifier 91 for repeats due to lab error/quality control/confirmation; modifiers 76/77 are inappropriate.
Key Terms and Modifiers
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