Lab Test
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Lab Test Receipt Example
This receipt documents a standard blood panel at LabCorp ordered by Dr. Sarah Park. Three tests are billed separately: CBC (CPT 85025, $42.00), CMP (CPT 80053, $78.00), and Lipid Panel (CPT 80061, $55.00), totaling $175.00. After a $52.25 insurance adjustment, Humana paid $92.75 of the $122.75 allowed amount, leaving a single $30.00 lab copay covering all three tests.
This lab test receipt documents a comprehensive metabolic panel (CPT 80053) and CBC with differential (CPT 85025) billed at $145 total with $105 insurance adjustment and $40 patient responsibility. The receipt itemizes each test with its CPT code for insurance and HSA documentation.
Receipt Breakdown
What Makes This Receipt Realistic
- • Three CPT codes billed separately, each test has its own line and amount
- • Single $30.00 lab copay covers all three panels ordered the same date
- • Ordering physician name on receipt, required for lab requisition
- • CPT 85025, 80053, 80061: the three most common routine blood panel codes
- • Math: $175.00 − $52.25 = $122.75 allowed; $122.75 − $92.75 = $30.00 lab copay
Frequently Asked Questions
What does this lab test receipt show?
This receipt documents blood work at LabCorp Patient Service Center, 680 N. Lake Shore Dr, Chicago, IL 60611. Patient: Christine L. Adams. Date of Service: April 15, 2025. Ordering Physician: Dr. Sarah Park, MD. Three CPT codes: 85025: Complete Blood Count with Differential ($42.00 billed), 80053: Comprehensive Metabolic Panel ($78.00 billed), 80061: Lipid Panel ($55.00 billed). Total Billed: $175.00. Insurance Adjustment: −$52.25. Allowed Amount: $122.75. Insurance Paid (Humana PPO): −$92.75. Lab Copay: $30.00. HSA/FSA Eligible.
Why does the lab receipt show three separate CPT codes?
Each lab test is a distinct billable service with its own CPT code, even when ordered together at the same visit. The CBC (85025), CMP (80053), and lipid panel (80061) are three separate assays processed and reported individually. Billing them separately allows the insurance company to apply different coverage rules to each test and ensures accurate coding for lab services. Some plans cover preventive screening panels (like a lipid panel ordered for cardiovascular risk assessment) at 100% while covering diagnostic panels at a copay tier, the separate CPT codes allow the insurer to make this distinction.
Does the lab copay cover all three tests or does each test have its own copay?
Under most insurance plans, a single lab copay ($15–$30) covers all tests ordered on the same date of service at the same lab facility, regardless of how many CPT codes appear on the claim. The $30.00 copay on this receipt covers all three panels, CBC, CMP, and lipid panel, ordered on the same date. If additional tests are ordered at a separate lab visit on a different date, a new copay would apply. Some high-deductible plans and certain specialty lab tests (genetic panels, complex pathology) may be subject to deductible rather than a flat copay.