LAB SERVICES

This program applies to the MMO PPO and MMO PPO/HSA plans only

A Maximum Allowable Cost (MAC) has been set for 40 routine blood tests. This was needed to avoid excessive costs that some labs charge for these simple, routine tests. Of the 40 tests for which a MAC has been set, 33 cost less than $10.00 each when performed by a lab that has agreed to this competitive, negotiated rate.

Do not overpay for these tests – be sure you have them performed by a lab that has agreed to charge no more than the MAC. Click HERE for a list of labs that have agreed to charge no more than the MAC (list current as of March, 2019 but subject to change).

Note that the MAC will NOT apply when any of the tests are done:

  • During an inpatient hospital stay; or,As part of an outpatient procedure; or,
  • During an emergency room visit for a true emergency; or,
  • By a provider outside the SuperMed® network service area

Read on for more details about this program that has been established to keep the cost of healthcare as afford-able as possible for all of us.

Who does this affect?

If you are enrolled in the Medical Mutual PPO or the PPO/HSA plan this affects you. If you have elected the MMO MedFlex or SkyCare EPO plan this change does not apply since coverage is only available from specific facilities and providers.

If a lab service charge is greater than the MAC how am I charged?

You will charged the amount over the MAC as an out-of-pocket expense. Amounts above the MAC are not a covered expense. For example, if the MAC for a service was $10 and the actual charge was $50, then the Plan would pay $10 and you would pay the remaining $40.

How do I make sure I’m not overcharged?

Check the cost using Medical Mutual’s My Care Compare tool. See the details below. Or to obtain the name and location of a provider that charges fees at or below the MAC, just call Medical Mutual’s Customer Care at  (800) 610-2583 during these times:

  • Monday through Thursday from 7:30 a.m. to 7:30 p.m.
  • Friday from 7:30 a.m. to 6 p.m.
  • Saturday from 9 a.m. to 1 p.m.

LAB TESTS with a Maximum Allowable Cost

The following is the list of blood tests that have a Maximum Allowable Cost. You can easily check what providers charge by using Medical Mutual’s My Care Compare tool (see details below). Or check the list of labs on the following page that have agreed to charge no more than the MAC for these tests.

Description CPT Code MAC
Basic Metabolic Panel 80048 $5.99
Electrolyte Panel 80051 $3.69
Comprehensive Metabolic Panel 80053 $8.62
Blood Lipid Panel Test (Cholesterol Test) 80061 $10.39
Renal Function Panel 80069 $7.09
Liver or Hepatic Function Test 80076 $5.16
Albumin; Serum 82040 $4.04
Total Bilirubin 82247 $3.29
Vitamin D 82306 $24.17
Total Calcium 82310 $4.21
Carbon Dioxide (Bicarbonate) 82374 $3.99
Chloride; Blood 82435 $3.76
Cholesterol, Serum or Whole Blood, Total 82465 $3.55
Creatinine; Blood 82565 $4.18
A1C Test-Diabetic Control Test 83036 $7.93
Lactate Dehydrogenase (LD), (LDH) 83615 $4.93
Lactate Dehydrogenase (LD), (LDH); Isoenzymes 83625 $10.45
Lipoprotein, Blood; Quantitation 83704 $25.76
Lipoprotein; High Density Cholesterol (HDL) 83718 $6.68
Lipoprotein, Direct Measurement; LDL Cholesterol 83721 $7.79
Phosphatase, Alkaline 84075 $4.22
Description CPT Code MAC
Potassium; Serum 84132 $3.76
Prostate-Specific Antigen (PSA) Test 84153 $15.02
Protein, Total, Except by Refractometry; Serum 84155 $2.99
Protein, Total, Except by Refractometry; Other Source 84157 $2.99
Sodium; Serum 84295 $3.93
Thyroid Stimulating Hormone (TSH) Test 84443 $13.72
Triglycerides 84478 $4.69
Blood Count; Automated Differential WBC Count 85004 $5.29
Blood Count; Blood Smear, Micro-scopic Exam w/Manual WBC 85007 $2.81
Blood Count; Blood Smear, Micro-scopic Exam w/o Manual WBC 85008 $1.28
Blood Count; Hematocrit (HCT) 85014 $1.94
Blood Count; Hemoglobin (HGB) 85018 $1.94
Blood Count; Automated Differential WBC Count 85025 $6.35
Blood Count; Complete (CBC), Automated 85027 $5.29
Blood Count; Red Blood Cell (RBC), Automated 85041 $2.35
Blood Count; Leukocyte (WBC), Automated 85048 $2.08
Blood Count; Platelet, Automated 85049 $3.65
Blood Smear, Peripheral, Interpretation with Written Report 85060 $14.61
Prothrombin Time 85610 $3.21

Location Finder

This finder includes labs that have agreed to charge no more than the MAC for the 40 tests listed above. If one of the locations is not close to you then use the My Care Compare tool or just call Medical Mutual’s Customer Care at (800) 610-2583. Please note that this list is subject to change so always confirm with the lab before receiving services.