Basic Metabolic Panel (BMP) (CPT 80048)
Medicare Rate vs. Lab Charges
Medicare pays $9.64 for this test. Labs commonly charge $35.00–$148.00. That's a 263%–1435% markup above what Medicare pays.
What This Test Is
A BMP measures 8 key chemicals: electrolytes (sodium, potassium, chloride, CO2), kidney function (BUN, creatinine), glucose, and sometimes calcium. It's ordered to monitor kidney and liver health, especially in patients on medications or with chronic conditions.
Medicare Rate vs. Lab Charges
| Medicare Allowable Rate | $9.64 |
| Typical Lab Charge Range | $35.00–$148.00 |
| Average Markup Above Medicare | 263%–1435% |
Does Medicare Cover This Test?
Yes, Medicare Part B covers BMP when ordered by a treating physician and medically necessary.
Common Reasons for Denial
- Ordered without clear clinical indication
- Duplicate test—recent BMP or CMP already in medical record
- Ordered too frequently (e.g., monthly without medication changes)
- No documented chronic condition or medication justification
- Screening test in asymptomatic, low-risk patient
What To Do If You're Overcharged
If you received a lab bill that seems unusually high compared to Medicare rates:
- Check your Explanation of Benefits (EOB) from Medicare or your insurance to see what should have been paid.
- Request an itemized bill from the lab showing all charges.
- Compare to GougeStop rates for your area to see if the charge is reasonable.
- Contact the lab's billing department to dispute erroneous charges or negotiate a lower rate.
- File an appeal with Medicare if a claim was incorrectly denied.
Frequently Asked Questions
A: BMP has 8 measurements (basic electrolytes and kidney function). CMP has 14 (includes liver function tests and more). Both are covered; your doctor chooses based on clinical need.
A: Initial BMP is often done before starting medication, then annually or as clinically indicated. If your medication changes, your doctor may order another BMP to check kidney function.
A: Lab overhead costs are fixed. Medicare rates don't reflect the full operational cost of the lab; they're a negotiated minimum.