Comprehensive Metabolic Panel (CMP) (CPT 80053)
Medicare Rate vs. Lab Charges
Medicare pays $14.35 for this test. Labs commonly charge $45.00–$237.00. That's a 214%–1552% markup above what Medicare pays.
What This Test Is
A comprehensive metabolic panel (CMP) measures 14 chemical compounds in your blood, including electrolytes, kidney function, liver function, and glucose levels. This test is commonly ordered during routine physicals, when monitoring chronic conditions, or as part of a comprehensive health assessment.
Medicare Rate vs. Lab Charges
| Medicare Allowable Rate | $14.35 |
| Typical Lab Charge Range | $45.00–$237.00 |
| Average Markup Above Medicare | 214%–1552% |
Does Medicare Cover This Test?
Yes, Medicare Part B covers CMP when ordered by your treating physician and deemed medically necessary.
Common Reasons for Denial
- Test ordered without medical necessity or clear clinical indication
- Ordered too frequently (e.g., more than once per year without change in condition)
- Duplicate test—another lab already performed the same test recently
- Ordered for screening purposes only in asymptomatic patients
- Ordered by a non-treating physician without established patient relationship
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: Labs charge different rates based on their overhead, location, and payer mix. Medicare rates are set by CMS; private insurance and self-pay patients often pay much more. The GougeStop app helps you compare prices before testing.
A: No. A BMP (Basic Metabolic Panel) includes 8 measurements, while a CMP includes 14. A CMP is more comprehensive and costs more.
A: Rarely, if it's clearly medically necessary. But some labs may bill it incorrectly or your doctor may order it without sufficient documentation—check your Explanation of Benefits.