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 Find a Provider and Cost Estimates 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.
