25-1239 Action Required: CPT Code 80050 Coverage Ends January 31, 2026
Date: 11/24/25
Submit individual lab codes to avoid claim denials
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The Centers for Medicare & Medicaid Services (CMS) previously removed CPT code 80050 from the Medicare Clinical Lab Fee schedule due to overuse. The bundled code was often submitted even when all included tests were not performed.
Coverage change, effective February 1, 2026
CPT code 80050 will no longer be covered for the following plans, in alignment with CMS guidance:
- Individual & Family Plans (Ambetter HMO, PPO)
- Employer Group Plans (HMO, POS, PPO)
What you need to do
To ensure proper reimbursement, submit the following lab codes individually starting February 1, 2026:
- 85003 – Comprehensive metabolic panel
- 85025, 85027 – Complete blood count
- 84443 – Thyroid stimulating hormone
System-generated denials
Claims submitted with CPT code 80050 after January 31, 2026, will be automatically denied with:
- Individual & Family Plans –
- Explanation code: 46
- Treatment type: NC
- Employer Group Plans –
- Disallow reason code: 49
Need help? Contact us
If you have questions, please reach out to the appropriate Provider Services Center:
- Individual & Family Plans (Ambetter HMO/PPO)
- Ambetter PPO: 844-463-8188
- Ambetter HMO: 888-926-2164
- Health Net Employer Groups (HMO, POS & PPO): 800-641-7761
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary Providers.