Lab billing looks simple until PAMA rate cuts, panel bundling rules, and LCD coverage restrictions collide — bill a component separately when a panel code applies, or run a molecular test without a covered ICD-10 code, and you're looking at a compliance violation, not just a denial.
Common Billing Challenges
These are the six billing failure points we see most often in laboratory practices — and the ones our team resolves systematically from day one.
Billing the individual components of a Basic Metabolic Panel (80047/80048) separately to capture higher reimbursement instead of the panel code is a compliance violation, not a coding preference.
Clinical Lab Fee Schedule rates are benchmarked against private payer data and phased in over multiple years — labs that aren't tracking their top-billed codes against the current CLFS are absorbing a rate cut quietly.
Tier 1 and Tier 2 molecular pathology and genomic sequencing codes (81105-81479) are audit magnets; every claim needs a documented clinical indication tied to a covered ICD-10 code.
When Medicare won't cover a test under LCD criteria, you need an ABN before running it — without one, a denial means the cost is the lab's, not the patient's.
A reflex test triggered automatically off a first result still needs its own billing support and a standing order that covers it — you can't bill a reflex test that wasn't authorized.
Physician offices with a CLIA waiver can only bill waived-complexity tests; billing moderate-complexity codes on a waived certificate is a compliance issue, not a simple denial.
Key Procedure Codes
Our coders hold specialty-specific credentials and train continuously on the codes that drive the most revenue — and the most denials — in laboratory billing.
| CPT/HCPCS Code | Description | Common Issue |
|---|---|---|
| 80047 / 80048 | Basic Metabolic Panel | Must bill as a panel when all components are run — not individually |
| 81105-81479 | Molecular pathology, Tier 1 / Tier 2 | Requires documented clinical indication tied to a covered ICD-10 code |
| BRCA / pharmacogenomic panels | Genetic testing codes | Tight NCD coverage restrictions; verify before running the test |
| ABN | Advance Beneficiary Notice | Required before running a test that doesn't meet LCD criteria |
| Reflex test codes | Auto-triggered follow-up testing | Needs a standing order or advance authorization to be billable |
Why Rcmaxis
We're not a generalist billing service that added a specialty module. Our team is built around specialty-specific expertise.
Every coder on your account holds the specialty coding credential relevant to laboratory services — not a generic CPC only.
Significantly above the denial patterns lab practices see from LCD mismatches and panel unbundling. Fewer rejections means faster payment and less write-off risk.
Full EHR integration, payer enrollment verification, and charge capture setup in 2 weeks — with zero disruption to your surgical schedule.
One point of contact who knows your practice, your payers, and your billing history — available for weekly calls and monthly performance reviews.
Month-to-month engagement. We earn your business every month by improving your collections — not by locking you in.
Live visibility into your collections, denial rate, aging AR, and payer performance — updated daily, reviewed monthly with your account team.
Straight answers to what practices usually ask before they switch.
Free revenue assessment for qualified practices. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.