A hepatic function panel and a comprehensive metabolic panel overlap far more than their names imply. Six of the hepatic panel's seven tests are already on a CMP. The comparison is not really "liver test versus metabolic test" — it is one extra liver analyte on one side against eight kidney, electrolyte and glucose analytes on the other, for a price difference of about two dollars.
The Verdict
The two panels side by side
Both are AMA-recognised panel codes, so their contents are fixed rather than set by each laboratory. The CPT 80076 hepatic function panel is seven analytes; CPT 80053 is fourteen.
| Hepatic function panel | Comprehensive metabolic panel | |
|---|---|---|
| CPT code | 80076 | 80053 |
| Number of tests | 7 | 14 |
| ALT, AST, alkaline phosphatase | Yes | Yes |
| Albumin, total protein | Yes | Yes |
| Bilirubin, total | Yes | Yes |
| Bilirubin, direct | Yes | No |
| Glucose | No | Yes |
| Sodium, potassium, chloride, CO₂ | No | Yes |
| BUN, creatinine | No | Yes |
| Calcium | No | Yes |
| GGT | No | No |
| Platelets / fibrosis score | No | No |
| Medicare rate, 2025–26 schedule | $8.17 | $10.56 |
Read down the table and the shape of the decision becomes obvious. Every liver enzyme and protein on the hepatic panel is on the CMP. The only row where the hepatic panel wins is direct bilirubin. The CMP wins eight rows, all of them outside the liver entirely — and the Medicare rates say it does so for $2.39, using the figures published on the Clinical Laboratory Fee Schedule for the 2025–26 period.
What only the hepatic function panel gives you
Direct bilirubin is the hepatic panel's single exclusive analyte, and its value is entirely conditional on the total bilirubin being raised. When total bilirubin is normal, fractionating it tells you nothing. When it is raised, fractionating it is the whole question.
The American College of Gastroenterology's 2017 guideline states that elevated serum total bilirubin levels should be fractionated to direct and indirect fractions, and that an elevated conjugated bilirubin implies hepatocellular disease or biliary obstruction in most settings. The corollary is the reassuring one: a raised total bilirubin that is almost entirely indirect, with normal enzymes, is very commonly Gilbert's syndrome — a benign inherited variant present in several percent of people that requires no treatment and no follow-up.
That is the practical difference between the two panels compressed into one sentence. A CMP showing a bilirubin of 1.8 mg/dL leaves you with a question. A hepatic function panel showing the same 1.8 mg/dL, of which 0.2 is direct, has usually answered it.
What only the CMP gives you
The CMP's eight additional analytes cover three systems the hepatic panel ignores completely. Glucose reports blood sugar at the moment of the draw. BUN and creatinine report kidney filtration, with eGFR calculated from creatinine, age and sex. Sodium, potassium, chloride and carbon dioxide report electrolytes and acid-base balance, and calcium sits alongside them.
Two of those matter more than they first appear in a liver context specifically. Kidney and liver problems travel together often enough — in advanced cirrhosis, in heart failure, in sepsis, and in the toxicity profile of a long list of drugs — that tracking one without the other is a false economy. And albumin, which both panels carry, is interpreted against calcium, which only the CMP carries, because a large fraction of circulating calcium is albumin-bound.
The full breakdown of what those eight analytes mean, including the two values a CMP calculates rather than measures, is in the CMP blood test guide.
Which to order, by situation
| Your situation | Better choice | Why |
|---|---|---|
| Jaundice, dark urine, or pale stools | Hepatic function panel | Direct bilirubin is the point. Fractionating a raised bilirubin is what separates obstruction from Gilbert's syndrome, and only this panel carries it. |
| Routine annual screening, no symptoms | CMP | Six of the seven liver numbers, plus kidney, electrolytes and glucose, for about $2 more. Broader coverage at effectively the same price. |
| Following up a previously abnormal ALT | Either — CMP is usually enough | The follow-up question is whether the transaminases moved. The CMP carries them, and adds kidney function you probably also want tracked. |
| Monitoring a drug known to affect the liver | Usually CMP | Most monitoring protocols track ALT, AST and bilirubin, all of which a CMP carries. Many of those drugs affect the kidneys too. |
| A raised alkaline phosphatase being worked up | Neither, alone — add GGT | Both panels contain alkaline phosphatase and neither contains GGT, so neither can tell you whether the source is liver or bone. |
| Chronic liver-risk screening (fatty liver, alcohol) | CMP plus a CBC | FIB-4 needs a platelet count, which neither panel includes. The platelets come from the complete blood count. |
One pattern runs through that table and is worth stating on its own. For most people, most of the time, the choice between these two panels is far less consequential than the choice of what to add to whichever one is drawn. The hepatic panel and the CMP disagree on one analyte. They agree in omitting GGT, platelets and any measure of fibrosis — and those omissions, not the direct bilirubin, are what most often leave a liver question unanswered after the results come back.
What neither panel does
Neither panel screens for liver scarring, which is the finding that changes prognosis. FIB-4 — the standard first-pass fibrosis screen — is calculated from AST, ALT, age and platelet count, and neither panel includes platelets. This is precisely why both major consumer liver products add them: Labcorp OnDemand's liver health test and Quest's liver function test panel both bundle a platelet count so they can report a FIB-4 score the underlying panel could not produce.
Neither panel identifies the source of a raised alkaline phosphatase, because neither contains GGT — the ACG recommends confirming an alkaline phosphatase elevation with GGT before treating it as hepatic at all. And neither is sensitive enough to exclude established disease: the ACG states plainly that a normal ALT level may not exclude significant liver disease, because a scarred liver has few cells left to leak enzyme into the blood.
When a result warrants seeing a physician
- Any raised bilirubin accompanied by jaundice, dark urine, pale stools or abdominal pain — the situation where fractionation is genuinely urgent rather than academic.
- A raised alkaline phosphatase on either panel, which needs GGT before it can be interpreted.
- ALT or AST above roughly five times the upper limit on either panel.
- A falling albumin on serial panels, which speaks to synthetic function rather than injury.
- Any abnormality that persists on a repeat draw without an obvious explanation such as recent heavy exercise or a new medication.
Choosing between these panels, and deciding what to add to either, is a clinical decision that depends on your symptoms, history and medications. Neither panel concludes anything on its own — both indicate where to look next, and the interpretation belongs with a clinician who can see the whole result in context.
Frequently Asked Questions
What is the difference between a hepatic function panel and a CMP?
A comprehensive metabolic panel contains 6 of the hepatic function panel's 7 tests, and adds 8 more. The overlap is ALT, AST, alkaline phosphatase, albumin, total protein and total bilirubin. The one test the hepatic function panel has that a CMP does not is direct (conjugated) bilirubin. Going the other way, the CMP adds glucose, calcium, sodium, potassium, chloride, carbon dioxide, BUN and creatinine — so it covers kidney function, electrolytes and blood sugar that the liver panel does not touch at all.
Is a hepatic function panel included in a CMP?
Almost, but not quite, and the exception is the clinically important one. A CMP carries six of the seven analytes, so in practice a CMP tells you nearly everything a hepatic function panel would about liver-cell injury and bile-duct obstruction. What it omits is direct bilirubin. That matters only when the bilirubin is actually raised — at which point the whole question becomes which fraction is raised, and the CMP cannot answer it. If a CMP shows a high total bilirubin, fractionation is usually ordered as a follow-up test.
Which is cheaper, a hepatic function panel or a CMP?
The hepatic function panel is marginally cheaper, and the gap is small enough to be irrelevant to the decision. On the Medicare Clinical Laboratory Fee Schedule for 2025–26, CPT 80076 is priced at $8.17 and CPT 80053 at $10.56. That is $2.39 for eight extra analytes covering kidney function, electrolytes and glucose. Self-pay and direct-to-consumer prices are far higher than both and do not always preserve the ordering — some consumer liver panels cost more than a consumer CMP because they bundle GGT and a fibrosis score.
Why would a doctor order a hepatic function panel instead of a CMP?
Usually because bilirubin is the question. The direct fraction is the panel's only exclusive analyte, and it is what distinguishes a benign unconjugated hyperbilirubinaemia such as Gilbert's syndrome from conjugated hyperbilirubinaemia, which the ACG notes implies hepatocellular disease or biliary obstruction in most settings. A patient presenting with jaundice is the clearest case. The other reason is narrower: some monitoring and billing protocols specify the hepatic panel by code, so it is ordered because the protocol names it rather than because it outperforms the alternative.
Does a CMP show liver problems?
Yes, for the great majority of liver problems that blood tests can detect at all. ALT, AST, alkaline phosphatase, albumin and total bilirubin all appear on a CMP, which is enough to classify an injury as hepatocellular, cholestatic or mixed using the ACG's R ratio. What a CMP will miss is the direct bilirubin fraction and — like the hepatic panel — GGT, fibrosis scoring and any imaging. It is also worth remembering that both panels can be entirely normal in established cirrhosis, because scarred tissue has few cells left to leak enzyme.
Can I order both a hepatic function panel and a CMP?
You can, and it is usually a waste. Six of the seven results would be duplicated in the same draw, and most laboratories and insurers treat the overlap as redundant billing. If the reason for wanting both is the direct bilirubin, the better route is a CMP plus a bilirubin fractionation, which some labs list as "bilirubin, direct" as a standalone add-on. If the reason is a suspected cholestatic problem, the higher-value addition is GGT, which neither panel contains.
Is a hepatic function panel the same as a liver panel?
In American lab ordering, "liver panel" usually means the CPT 80076 hepatic function panel, but the term is not standardised and consumer products vary widely. Labcorp's consumer liver test carries the seven analytes plus platelets and a FIB-4 score. Quest's consumer liver panel adds GGT, globulin and the indirect bilirubin fraction on top of that. Because "liver panel" can mean any of these, the reliable way to know what you are buying is to read the list of included analytes rather than the product name.
Do both panels need fasting?
The liver analytes do not, but the CMP does — and that difference is the reason so many people are told to fast for what they were told was a liver test. Glucose is the driver: it is uninterpretable without a defined fasting state, so a CMP is normally drawn after 8 to 12 hours without food, water permitted. A hepatic function panel drawn on its own carries no such requirement, and both Labcorp and Quest state that no special preparation is needed for their consumer liver panels. Recent exercise and alcohol move the liver analytes more than a meal does, which is covered in how to prepare for a liver panel.