Non-Coverage of CPT Code 80050
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Healthfirst will deny reimbursement for CPT 80050 (General Health Panel) for claims with dates of service on or after July 1, 2026; applies to participating and non‑participating providers across the Healthfirst lines of business listed in the policy.
Effective July 1, 2026, Healthfirst will no longer reimburse for CPT code 80050 (General Health Panel).
Coverage Determination for CPT 80050
Non-Coverage and Billing Criteria for CPT 80050
Covered when ALL of the following are met:
ALL of the following
- Policy effective date: applies to all claims with dates of service on or after July 1, 2026.
- Applies to all participating and non‑participating providers, all Healthfirst products and lines of business listed in the policy, and all places of service unless otherwise required by law or specified in a provider contract.
Codes and Effective Date
| 80050 | General health panel |
| 80053 | Comprehensive metabolic panel (component of 80050) |
| 85025 | Blood count, complete (CBC), automated and automated differential WBC count |
| 85027 | Blood count, complete (CBC), automated |
| 85004 | Automated differential WBC count |
| 85007 | Manual differential WBC count |
| 85009 | Manual differential WBC count (alternate) |
| 84443 | Thyroid stimulating hormone (TSH) |
Billing and Submission Instructions for Providers
Do not bill CPT 80050; submit component codes with medical necessity and documentation
Claims billed with CPT 80050 will be denied as non-covered for dates of service on or after July 1, 2026; when medically necessary, bill the individual component test codes instead and ensure documentation supports medical necessity and coverage under the member’s benefit plan. Claims that do not adhere to this policy will be denied or rejected; follow timely filing and provider contract requirements and appeal per the provider contract and Healthfirst Provider Manual.
- CPT 80050 is non‑reimbursable — any claim with CPT 80050 will be denied.
- Providers may bill individual laboratory test components included within CPT 80050 when the services are medically necessary, appropriately documented, covered under the member’s benefit plan, and billed in compliance with CMS, NYS Medicaid, and Healthfirst billing policies.
- If CPT 80050 is billed with its component codes, only the panel code will be denied.
- Claims not adhering to this policy will be denied or rejected; providers must follow timely filing requirements in their provider contract and the Healthfirst Provider Manual and may appeal per contractual terms.
Key Definitions
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