We want to alert you to a change from Ambetter (Louisiana) regarding lab billing practices that may affect your lab claims submissions.
What’s changing?
- Starting October 1, 2025, Ambetter will discontinue coverage of HCPCS bundled code 80050.
- Instead, Ambetter will only reimburse the individual component CPT/HCPCS codes:
• 85003 for Comprehensive Metabolic Panel
• 85025 & 85027 for Complete Blood Count
• 84443 for Thyroid Stimulating Hormone [Ambetter Health] - Claims submitted with the bundled code 80050 after September 30, 2025 will be automatically denied. The denial will come with explanation code 46 and treatment type NC.
Why this change?
Ambetter is aligning with CMS, which removed HCPCS 80050 from the Medicare Clinical Lab Fee Schedule due to concerns about overuse when not all component tests were performed.
What you need to do:
- Review your lab order workflows
Ensure your EMR/lab requisition tools don’t default to 80050. - Update billing and coding practices
Submit the individual codes (85003, 85025, 85027, 84443) as appropriate. - Train your billing/coding staff and labs
Make sure your teams, including external lab partners, know about the change. - Monitor claims denials closely in October onward
Look for denials with code 46 / NC and correct by resubmitting with individual codes. - Contact your Ambetter/provider support team if needed
If you need help, reach out to provider relations or support as specified by Ambetter.