How testing bills

Clinicore operates a compliant, patient-friendly billing model. What that means in practice is set out below — the structure matters, because how a test bills is not always how it is ordered.

A profile is not a billable panel

This is the distinction that catches practices out, and it is the reason it sits first on this page.

AMA-defined panels bill as a single unit under one code. The basic metabolic panel bills under 80048, the comprehensive metabolic panel under 80053, the lipid panel under 80061. The components are the panel’s definition, not a menu, and they are not billed separately.

Clinicore lab profiles are an ordering convenience. The sex steroid profile, the corticosteroid profile and the thyroid profile group tests that are usefully ordered together, but each component bills under its own CPT and the total is the sum of its parts. There is no panel code, because the AMA does not define one.

Every panel page on this site states which model applies, at the top.

Definitive toxicology bills by drug class

Definitive drug testing bills from the G-code family by the number of drug classes ordered — not per analyte. Individual toxicology analytes carry AMA CPT codes, but in practice almost every payer bills on the class count.

This is why no toxicology analyte page on this site publishes a CPT code. Publishing one would lead a practice manager to the wrong conclusion about how the test bills.

Definitive drug testing is also subject to frequency and medical-necessity limits under most contractor policies.

Cash-only testing

MTHFR and COMT genotyping is cash only, collected from the patient at the draw. No claim is filed and no ABN applies.

Coverage

Clinicore makes no claim of network participation with any payer. Coverage depends on the patient’s plan, the diagnosis reported, and the payer’s own policy — none of which the laboratory controls, and any of which can change without notice.

A patient may be responsible for amounts their plan does not cover. That is the same position the consent language on every Clinicore requisition states, and this page does not contradict it.

Questions

Billing questions go through the contact page, which has a billing path. Please do not include patient names, dates of birth or specimen identifiers in any web form.