Hepatic Function Panel (CPT 80076)
Medicare Rate vs. Lab Charges
Medicare pays $10.41 for this test. Labs commonly charge $40.00–$170.00. That's a 284%–1534% markup above what Medicare pays.
What This Test Is
A hepatic (liver) function panel measures liver enzymes and bilirubin to assess liver health. It's ordered to check for liver disease, monitor medications that affect the liver, or evaluate jaundice and abdominal pain. It includes AST, ALT, ALP, bilirubin, and albumin.
Medicare Rate vs. Lab Charges
| Medicare Allowable Rate | $10.41 |
| Typical Lab Charge Range | $40.00–$170.00 |
| Average Markup Above Medicare | 284%–1534% |
Does Medicare Cover This Test?
Yes, Medicare Part B covers hepatic function panels when medically necessary—to monitor chronic liver disease, check medication side effects, or evaluate acute symptoms.
Common Reasons for Denial
- Screening in asymptomatic patient without liver disease risk
- Tested too frequently without medication changes or symptom worsening
- No documented medical indication in patient record
- Duplicate test within short timeframe
- Routine monitoring without clear clinical justification
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: Many—including statins, acetaminophen, NSAIDs, antibiotics, and anticonvulsants. Your doctor should order baseline and periodic testing if you take these regularly.
A: Baseline testing before starting hepatotoxic medication, then every 6-12 months if on long-term therapy. More frequent testing if dose changes.
A: Hospital labs typically charge more than independent labs. Many tests are bundled differently, leading to wide price variation.