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QuestDiagnostics.com
Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics.
All third party marks - and - are the property of their respective owners. 2016 Quest Diagnostics Incorporated. All rights reserved
Policies in this MLCP Reference Guide apply to testing performed at a Quest Diagnostics facility and apply to Medicare National Coverage Determination Policy.
This diagnosis code reference guide is provided as an aid to physicians and office staff in determining when an ABN (Advance Beneficiary Notice) is necessary.
Diagnosis codes must be applicable to the patients symptoms or conditions and must be consistent with documentation in the patients medical record.
Quest Diagnostics does not recommend any diagnosis codes and will only submit diagnosis information provided to us by the ordering physician or his/her
designated staff. The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing
party. Please direct any questions regarding coding to the payer being billed.
Medicare National and Local Coverage Determination Policy- CT, MA, ME, NH, RI, VT
10/01/16
Click here for Local MLCP Policies Tool Document contains information on Medicare Local
Limited Coverage Policies for lab testing performed in
CT, MA, ME, NH, RI, VT
B-type Natriuretic Peptide (BNP) Testing
Combined Ovarian Cancer Biomarker Tests
Genomic Sequence Analysis Panels in the Treatment of Non-Small
Cell Lung Cancer
Heavy Metal Testing
Molecular Pathology Procedures
Non-covered Services
RAST Type Tests
Urine Drug Testing
Vitamin D Assay Testing
Click here for National MLCP Policies Tool
Document contains information on National Medicare
Limited Coverage Policies
Alpha-Fetoprotein
Blood Counts
Blood Glucose Testing
Carcinoembryonic Antigen
Collagen Crosslinks - Any Method
Digoxin Therapeutic Drug Assay
Fecal Occult Blood
Gamma Glutamyl Transferase
Glycated Hemoglobin - Glycated Protein
Hepatitis Panel/Acute Hepatitis Panel
Human Chorionic Gonadotropin
Human Immunodeficiency Virus (HIV) Testing
(Diagnosis)
Human Immunodeficiency Virus (HIV) Testing
(Prognosis Including Monitoring)
Lipids Testing
Partial Thromboplastin Time (PTT)
Prostate Specific Antigen
Prothrombin Time (PT)
Serum Iron Studies
Thyroid Testing
Tumor Antigen by Immunoassay CA 15-3 CA 27.29
Tumor Antigen by Immunoassay CA 19-9
Tumor Antigen by Immunoassay CA-125
Urine Culture, Bacterial
http://questnet1.qdx.com/index.hthttps://www.cms.gov/Medicare/Coverage/CoverageGenInfo/Downloads/manual201610_ICD10.pdf
Last Updated:
This list was compiled from Medicares Limited Coverage Policies for informational and reference purposes only. For the most current information please reference www.cms.gov.
Note: If the patients medical record does not support one of the above ICD-10-CM codes, please prepare an Advance Beneficiary Notice form, and ask the patient to read and sign it.
Source: Federal Registry Negotiated Rule-making, November 23, 2001
The cpt codes provided are based on ama guidelines and are for informational purposes only. Cpt coding is the sole responsibility of the billing party.
Please direct any questions regarding coding to the payer being billed.
Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics.
All third party marks - and - are the property of their respective owners. 2016 Quest Diagnostics Incorporated. All rights reserved
Medicare Local Coverage Determination Policy- CT, MA, ME, NH, RI, VT
B-type Natriuretic Peptide (BNP) Testing CPT Code: 83880
LCD Description: B-type natriuretic peptide (BNP) is a cardiac neurohormone produced mainly in the left ventricle. It is secreted in response to ventricular volume expansion
and pressure overload, factors often found in congestive heart failure (CHF). Used in conjunction with other clinical information, rapid measurement of BNP is useful in
establishing or excluding the diagnosis and assessing the severity of CHF in patients with acute dyspnea so that appropriate and timely treatment can be initiated.
ICD-10-CM Codes that Support Medical Necessity are listed, but it is not enough to link the procedure code to a correct payable ICD-10-CM code. The diagnosis
must be present for the procedure to be paid and the procedure must be reasonable and medically necessary for that diagnosis. Documentation within the patients medical
record must support the medical necessity for the test(s) provided. This list was compiled from the Medicare Local Coverage Determination Policy. An ICD-10-CM book
should be used as a complete reference.
Table 1: ICD-10-CM codes that support medical necessity when billed in
either an office or outpatient setting.
Group 1 Codes:
E85.0 Non-neuropathic heredofamilial amyloidosis
E85.1 Neuropathic heredofamilial amyloidosis
E85.2 Heredofamilial amyloidosis, unspecified
E85.3 Secondary systemic amyloidosis
E85.4 Organ-limited amyloidosis
E85.8 Other amyloidosis
E85.9 Amyloidosis, unspecified
I11.0 Hypertensive heart disease with heart failure
I13.0 Hypertensive heart and chronic kidney disease with heart failure and
stage 1 through stage 4 chronic kidney disease, or unspecified chronic
kidney disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with
stage 5 chronic kidney disease, or end stage renal disease
I50.1 Left ventricular failure
I50.20 Unspecified systolic (congestive) heart failure
I50.21 Acute systolic (congestive) heart failure
I50.22 Chronic systolic (congestive) heart failure
I50.23 Acute on chronic systolic (congestive) heart failure
I50.30 Unspecified diastolic (congestive) heart failure
I50.31 Acute diastolic (congestive) heart failure
I50.32 Chronic diastolic (congestive) heart failure
I50.33 Acute on chronic diastolic (congestive) heart failure
I50.40 Unspecified combined systolic (congestive) and diastolic (congestive)
heart failure
I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart
failure
I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart
failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive)
heart failure
I50.9 Heart failure, unspecified
J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection
J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
J45.901 Unspecified asthma with (acute) exacerbation
J98.01 Acute bronchospasm
R06.00 Dyspnea, unspecified
R06.01 Orthopnea
R06.02 Shortness of breath
R06.09 Other forms of dyspnea
R06.2 Wheezing
R06.82 Tachypnea, not elsewhere classified
R06.89 Other abnormalities of breathing
R06.9 Unspecified abnormalities of breathing
Utilization Guidelines: The use of BNP for monitoring CHF is not covered.
Limitations: BNP measurements must be analyzed in conjunction with standard diagnostic tests,
medical history and clinical findings. The efficacy of BNP measurement as a stand-alone test has
not yet been established. Clinicians should be aware that certain conditions such as ischemia,
infarction and renal insufficiency, may cause elevation of circulating BNP concentration and
require alterations of the interpretation of BNP results.
Additional investigation is required to further define the diagnostic value of plasma BNP in
monitoring the efficiency of treatment for CHF and in tailoring the therapy for heart failure.
Therefore, BNP measurements for monitoring and management of CHF are not a covered service.
Although a correlation between serum BNP levels and the clinical severity of HF has been shown
in broad populations, it cannot be assumed that BNP levels can be used effectively as targets for
adjustment of therapy in individual patients. [T]he BNP measurement has not been clearly shown
to supplement careful clinical assessment. (Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA
2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: A
Report of the American College of Cardiology/American Heart Association Task Force on Practice
Guidelines, pgs. 14-15)
Data Source: Local Coverage Determination (LCD): B-type Natriuretic Peptide (BNP) Testing (L33573)
07/01/16
http://questnet1.qdx.com/index.hthttps://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33573&ContrId=299&ver=7&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAIAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33573&ContrId=299&ver=7&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAIAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33573&ContrId=299&ver=7&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAIAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33573&ContrId=299&ver=7&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAIAAAAAAA%3d%3d&
Last Updated:
This list was compiled from Medicares Limited Coverage Policies for informational and reference purposes only. For the most current information please reference www.cms.gov.
Note: If the patients medical record does not support one of the above ICD-10-CM codes, please prepare an Advance Beneficiary Notice form, and ask the patient to read and sign it.
Source: Federal Registry Negotiated Rule-making, November 23, 2001
The cpt codes provided are based on ama guidelines and are for informational purposes only. Cpt coding is the sole responsibility of the billing party.
Please direct any questions regarding coding to the payer being billed.
Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics.
All third party marks - and - are the property of their respective owners. 2016 Quest Diagnostics Incorporated. All rights reserved
Medicare Local Coverage Determination Policy- CT, MA, ME, NH, RI, VT
Combined Ovarian Cancer Biomarker Tests CPT Code: 81500, 81503, 84999
LCD Description: OVA-1 is an ovarian cancer blood test that is reported to detect ovarian cancer in a pelvic mass. It is an aggregation of five biomarkers, beta 2-
microglobulin, apolipoprotein A-1, CA-125, transferrin and transthyretin. The Risk of Ovarian Malignancy Algorithm (ROMA), is another test which combines the same
traditionally proven tumor marker, CA-125, with HE-4, human epidydimus protein 4, a relatively new protein marker produced by the over-expression of the gene WFDC2,
and associated with epithelial ovarian neoplasia.
ICD-10-CM Codes that Support Medical Necessity are listed, but it is not enough to link the procedure code to a correct payable ICD-10-CM code. The diagnosis
must be present for the procedure to be paid and the procedure must be reasonable and medically necessary for that diagnosis. Documentation within the patients
medical record must support the medical necessity for the test(s) provided. This list was compiled from the Medicare Local Coverage Determination Policy. An ICD-10-CM
book should be used as a complete reference.
CPT/HCPCS Codes
Group 1 Paragraph: N/A
Group 1 Codes:
81500 ONCOLOGY (OVARIAN), BIOCHEMICAL ASSAYS OF TWO PROTEINS (CA-125 AND HE4), UTILIZING SERUM, WITH MENOPAUSAL STATUS,
ALGORITHM REPORTED AS A RISK SCORE
81503 ONCOLOGY (OVARIAN), BIOCHEMICAL ASSAYS OF FIVE PROTEINS (CA-125, APOLIPOPROTEIN A1, BETA-2 MICROGLOBULIN, TRANSFERRIN,
AND PRE-ALBUMIN), UTILIZING SERUM, ALGORITHM REPORTED AS A RISK SCORE
84999 UNLISTED CHEMISTRY PROCEDURE
ICD-10 Codes that Support Medical Necessity
Group 1 Paragraph: N/A
ICD-10 Codes that DO NOT Support Medical Necessity N/A
Indications and Limitations:
Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits.
At the present time, National Government Services does not find either the OVA-1 or the ROMA test to be of proven efficacy in the diagnosis or treatment of ovarian
cancer. National Government Services will only allow coverage of CA-125 as allowed by the national coverage decision.
Data Source: Local Coverage Determination for Combined Ovarian Cancer Biomarker Tests (L33588)
10/01/15
http://questnet1.qdx.com/index.hthttp://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=32965&ContrId=180&ver=8&ContrVer=1&CntrctrSelected=180*1&Cntrctr=180&name=National+Government+Services,+Inc.+(13102,+MAC+-+Part+B)&DocType=Active&LCntrctr=54*1|55*1|56*1|52*1|53*1|51*1|57*1|63*1|89*1|64*1|65*1|192*1|1*1|2*1|178*1|180*1|179*1|181*1|182*1|183*1|138*1&bc=AgACAAIAAAAAAA==&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33588&ContrId=299&ver=4&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAIAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33588&ContrId=299&ver=4&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAIAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33588&ContrId=299&ver=4&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAIAAAAAAA%3d%3d&
Last Updated:
This list was compiled from Medicares Limited Coverage Policies for informational and reference purposes only. For the most current information please reference www.cms.gov.
Note: If the patients medical record does not support one of the above ICD-10-CM codes, please prepare an Advance Beneficiary Notice form, and ask the patient to read and sign it.
Source: Federal Registry Negotiated Rule-making, November 23, 2001
The cpt codes provided are based on ama guidelines and are for informational purposes only. Cpt coding is the sole responsibility of the billing party.
Please direct any questions regarding coding to the payer being billed.
Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics.
All third party marks - and - are the property of their respective owners. 2016 Quest Diagnostics Incorporated. All rights reserved
Medicare Local Coverage Determination Policy- CT, MA, ME, NH, RI, VT
Genomic Sequence Analysis Panels in the Treatment
of Non-Small Cell Lung Cancer CPT Code: 81445
LCD Description: Most lung cancers are epithelial in origin, with squamous cell carcinomas, adenocarcinomas, and small cell carcinomas being the predominant histologic
types. The first two, squamous and adenocarcinomas, have been traditionally grouped as non-small cell lung cancer (NSCLC). Surgery remains the cornerstone of treatment
for early stage NSCLC of either type, however treatment of advanced stage disease is based primarily on drugs. Distinctive response patterns to specific therapeutic drugs
have been demonstrated over the past 12 years, necessitating the distinction between squamous cell and adenocarcinoma morphology. Consequently the most recent WHO
guidelines advocate sub-classification of all NSCLC in to a more specific subtype whenever possible. This is typically accomplished by histologic evaluation with support from
specific immunohistochemical studies, which are particularly useful in the evaluation of small biopsies.
ICD-10-CM Codes that Support Medical Necessity are listed, but it is not enough to link the procedure code to a correct payable ICD-10-CM code. The diagnosis
must be present for the procedure to be paid and the procedure must be reasonable and medically necessary for that diagnosis. Documentation within the patients medical
record must support the medical necessity for the test(s) provided. This list was compiled from the Medicare Local Coverage Determination Policy. An ICD-10-CM book
should be used as a complete reference.
TARGETED GENOMIC SEQUENCE ANALYSIS PANEL, SOLID ORGAN NEOPLASM, DNA
ANALYSIS, AND RNA ANALYSIS WHEN PERFORMED, 5-50 GENES (EG, ALK, BRAF,
CDKN2A, EGFR, ERBB2, KIT, KRAS, NRAS, MET, PDGFRA, PDGFRB, PGR, PIK3CA,
PTEN, RET), INTERROGATION FOR SEQUENCE VARIANTS AND COPY NUMBER
VARIANTS OR REARRANGEMENTS, IF PERFORMED
C33 Malignant neoplasm of trachea
C34.00 Malignant neoplasm of unspecified main bronchus
C34.01 Malignant neoplasm of right main bronchus
C34.02 Malignant neoplasm of left main bronchus
C34.10 Malignant neoplasm of upper lobe, unspecified bronchus or lung
C34.11 Malignant neoplasm of upper lobe, right bronchus or lung
C34.12 Malignant neoplasm of upper lobe, left bronchus or lung
C34.2 Malignant neoplasm of middle lobe, bronchus or lung
C34.30 Malignant neoplasm of lower lobe, unspecified bronchus or lung
C34.31 Malignant neoplasm of lower lobe, right bronchus or lung
C34.32 Malignant neoplasm of lower lobe, left bronchus or lung
C34.80 Malignant neoplasm of overlapping sites of unspecified bronchus and lung
C34.81 Malignant neoplasm of overlapping sites of right bronchus and lung
C34.82 Malignant neoplasm of overlapping sites of left bronchus and lung
C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung
C34.91 Malignant neoplasm of unspecified part of right bronchus or lung
C34.92 Malignant neoplasm of unspecified part of left bronchus or lung
C38.4 Malignant neoplasm of pleura
C45.0 Mesothelioma of pleura
Data Source: Genomic Sequence Analysis Panels in the Treatment of Non-Small Cell Lung Cancer
(L36376)
4/01/16
Indications and Limitations of Coverage
Genomic Sequential Analysis Panel represented by CPT 81445 will be considered
reasonable and necessary in the evaluation of tumor tissue in the following clinical
circumstances:
Newly diagnosed patients with advanced (stage IIIB or IV) NSCLC, who are not
treatable by resection or radiation with curative intent, and who are suitable candidates
for therapy at the time of testing.
Previously diagnosed patients with advanced (stage IIIB or IV) NSCLC, who have not
responded to at least one systemic therapy, or who have progressed following
resection. The patient must be a candidate for treatment at the time of the testing.
Previously diagnosed patients with advanced (stage IIIB or IV) NSCLC, who have
been resistant to at least one targeted therapy, are able to undergo tumor tissue
biopsy for testing, and who are suitable candidates for additional treatment at the time
of testing.
Utilization Guidelines
Screening services such as pre-symptomatic genetic tests and services used to detect
an undiagnosed disease or disease predisposition are not a Medicare benefit and are
not covered. Similarly, Medicare may not reimburse the costs of tests/examinations
that assess the risk of a condition unless the risk assessment clearly and directly
effects the management of the patient.
http://questnet1.qdx.com/index.hthttp://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=32965&ContrId=180&ver=8&ContrVer=1&CntrctrSelected=180*1&Cntrctr=180&name=National+Government+Services,+Inc.+(13102,+MAC+-+Part+B)&DocType=Active&LCntrctr=54*1|55*1|56*1|52*1|53*1|51*1|57*1|63*1|89*1|64*1|65*1|192*1|1*1|2*1|178*1|180*1|179*1|181*1|182*1|183*1|138*1&bc=AgACAAIAAAAAAA==&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=36376&ContrId=299&ver=3&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&DocType=Active&LCntrctr=299*1&bc=AgACAAIAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=36376&ContrId=299&ver=3&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&DocType=Active&LCntrctr=299*1&bc=AgACAAIAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=36376&ContrId=299&ver=3&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&DocType=Active&LCntrctr=299*1&bc=AgACAAIAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=36376&ContrId=299&ver=3&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&DocType=Active&LCntrctr=299*1&bc=AgACAAIAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=36376&ContrId=299&ver=3&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&DocType=Active&LCntrctr=299*1&bc=AgACAAIAAAAAAA%3d%3d&
Last Updated:
This list was compiled from Medicares Limited Coverage Policies for informational and reference purposes only. For the most current information please reference www.cms.gov.
Note: If the patients medical record does not support one of the above ICD-10-CM codes, please prepare an Advance Beneficiary Notice form, and ask the patient to read and sign it.
Source: Federal Registry Negotiated Rule-making, November 23, 2001
The cpt codes provided are based on ama guidelines and are for informational purposes only. Cpt coding is the sole responsibility of the billing party.
Please direct any questions regarding coding to the payer being billed.
Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics.
All third party marks - and - are the property of their respective owners. 2016 Quest Diagnostics Incorporated. All rights reserved
Medicare Local Coverage Determination Policy- CT, MA, ME, NH, RI, VT
Heavy Metal Testing (pg. 1 of 10) CPT Codes: 82108, 82175, 82300, 82495, 82525, 83018,
83655, 83785, 83825, 83885, 84255, 84285, 84630
LCD Description: The term heavy metal testing is historically used to describe elements such as lead, arsenic, mercury, cadmium, and chromium. In general, all of the heavy
metals in inorganic form cause GI irritation, resulting in nausea, vomiting, abdominal pain and diarrhea. The next most consistent toxicity for the heavy metals as a group, but not
for every heavy metal, is renal toxicity. A further generalization is that each member of the heavy metal group tends to cause multi-organ toxicity. Many metals cause cutaneous
abnormalities, such as irritant and allergic contact dermatitis, urticaria, keratoses, and premalignant and malignant lesions. Several of the heavy metals produce central and
peripheral nervous system toxicity. Other metals cause pulmonary illness. However, before any testing for heavy metal is ordered, a detailed medical history of the patient must
be obtained, including a careful documentation of occupational and avocational exposure to these toxins. A complete physical examination must be done. While classified as
heavy metals, this policy does not include iron or lithium since the former is typically tested for anemia issues and the latter is typically tested for monitoring of medications. In
addition, iron testing is covered under the National Coverage Determination 190.18 (Serum Iron Studies).
ICD-10-CM Codes that Support Medical Necessity are listed, but it is not enough to link the procedure code to a correct payable ICD-10-CM code. The diagnosis must
be present for the procedure to be paid and the procedure must be reasonable and medically necessary for that diagnosis. Documentation within the patients medical record
must support the medical necessity for the test(s) provided. This list was compiled from the Medicare Local Coverage Determination Policy. An ICD-10-CM book should be
used as a complete reference.
CPT 82108, Aluminum- Serum aluminum testing is payable for beneficiaries
who have been on dialysis with evidence suggesting aluminum toxicity, or
for beneficiaries with chronic industrial exposure history
F06.8 Other specified mental disorders due to known physiological condition
F11.121 Opioid abuse with intoxication delirium
F11.122 Opioid abuse with intoxication with perceptual disturbance
F11.14 Opioid abuse with opioid-induced mood disorder
F11.188 Opioid abuse with other opioid-induced disorder
F11.221 Opioid dependence with intoxication delirium
F11.24 Opioid dependence with opioid-induced mood disorder
F11.288 Opioid dependence with other opioid-induced disorder
F11.921 Opioid use, unspecified with intoxication delirium
F11.929 Opioid use, unspecified with intoxication, unspecified
F11.94 Opioid use, unspecified with opioid-induced mood disorder
F11.988 Opioid use, unspecified with other opioid-induced disorder
F12.121 Cannabis abuse with intoxication delirium
F12.129 Cannabis abuse with intoxication, unspecified
F12.159 Cannabis abuse with psychotic disorder, unspecified
F12.188 Cannabis abuse with other cannabis-induced disorder
F12.221 Cannabis dependence with intoxication delirium
F12.229 Cannabis dependence with intoxication, unspecified
F12.288 Cannabis dependence with other cannabis-induced disorder
F12.921 Cannabis use, unspecified with intoxication delirium
F12.929 Cannabis use, unspecified with intoxication, unspecified
Data Source: Local Coverage Determination
for Heavy Metal Testing (L35074)
10/01/16
F12.988 Cannabis use, unspecified with other cannabis-induced disorder
F13.121 Sedative, hypnotic or anxiolytic abuse with intoxication delirium
F13.129 Sedative, hypnotic or anxiolytic abuse with intoxication, unspecified
F13.14 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-
induced mood disorder
F13.159 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-
induced psychotic disorder, unspecified
F13.188 Sedative, hypnotic or anxiolytic abuse with other sedative, hypnotic or
anxiolytic-induced disorder
F13.221 Sedative, hypnotic or anxiolytic dependence with intoxication delirium
F13.229 Sedative, hypnotic or anxiolytic dependence with intoxication, unspecified
F13.24 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or
anxiolytic-induced mood disorder
F13.259 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or
anxiolytic-induced psychotic disorder, unspecified
F13.26 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or
anxiolytic-induced persisting amnestic disorder
F13.27 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or
anxiolytic-induced persisting dementia
F13.921 Sedative, hypnotic or anxiolytic use, unspecified with intoxication delirium
F13.929 Sedative, hypnotic or anxiolytic use, unspecified with intoxication,
unspecified
F13.94 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or
anxiolytic-induced mood disorder
http://questnet1.qdx.com/index.hthttp://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=32965&ContrId=180&ver=8&ContrVer=1&CntrctrSelected=180*1&Cntrctr=180&name=National+Government+Services,+Inc.+(13102,+MAC+-+Part+B)&DocType=Active&LCntrctr=54*1|55*1|56*1|52*1|53*1|51*1|57*1|63*1|89*1|64*1|65*1|192*1|1*1|2*1|178*1|180*1|179*1|181*1|182*1|183*1|138*1&bc=AgACAAIAAAAAAA==&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&
Last Updated:
This list was compiled from Medicares Limited Coverage Policies for informational and reference purposes only. For the most current information please reference www.cms.gov.
Note: If the patients medical record does not support one of the above ICD-10-CM codes, please prepare an Advance Beneficiary Notice form, and ask the patient to read and sign it.
Source: Federal Registry Negotiated Rule-making, November 23, 2001
The cpt codes provided are based on ama guidelines and are for informational purposes only. Cpt coding is the sole responsibility of the billing party.
Please direct any questions regarding coding to the payer being billed.
Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics.
All third party marks - and - are the property of their respective owners. 2016 Quest Diagnostics Incorporated. All rights reserved
Medicare Local Coverage Determination Policy- CT, MA, ME, NH, RI, VT
Heavy Metal Testing (pg. 2 of 10) CPT Codes: 82108, 82175, 82300, 82495, 82525, 83018,
83655, 83785, 83825, 83885, 84255, 84285, 84630
LCD Description: The term heavy metal testing is historically used to describe elements such as lead, arsenic, mercury, cadmium, and chromium. In general, all of the heavy
metals in inorganic form cause GI irritation, resulting in nausea, vomiting, abdominal pain and diarrhea. The next most consistent toxicity for the heavy metals as a group, but not
for every heavy metal, is renal toxicity. A further generalization is that each member of the heavy metal group tends to cause multi-organ toxicity. Many metals cause cutaneous
abnormalities, such as irritant and allergic contact dermatitis, urticaria, keratoses, and premalignant and malignant lesions. Several of the heavy metals produce central and
peripheral nervous system toxicity. Other metals cause pulmonary illness. However, before any testing for heavy metal is ordered, a detailed medical history of the patient must
be obtained, including a careful documentation of occupational and avocational exposure to these toxins. A complete physical examination must be done. While classified as
heavy metals, this policy does not include iron or lithium since the former is typically tested for anemia issues and the latter is typically tested for monitoring of medications. In
addition, iron testing is covered under the National Coverage Determination 190.18 (Serum Iron Studies).
ICD-10-CM Codes that Support Medical Necessity are listed, but it is not enough to link the procedure code to a correct payable ICD-10-CM code. The diagnosis must
be present for the procedure to be paid and the procedure must be reasonable and medically necessary for that diagnosis. Documentation within the patients medical record
must support the medical necessity for the test(s) provided. This list was compiled from the Medicare Local Coverage Determination Policy. An ICD-10-CM book should be
used as a complete reference.
F13.96 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic
or anxiolytic-induced persisting amnestic disorder
F13.97 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic
or anxiolytic-induced persisting dementia
F13.988 Sedative, hypnotic or anxiolytic use, unspecified with other sedative,
hypnotic or anxiolytic-induced disorder
F14.121 Cocaine abuse with intoxication with delirium
F14.129 Cocaine abuse with intoxication, unspecified
F14.14 Cocaine abuse with cocaine-induced mood disorder
F14.188 Cocaine abuse with other cocaine-induced disorder
F14.221 Cocaine dependence with intoxication delirium
F14.229 Cocaine dependence with intoxication, unspecified
F14.24 Cocaine dependence with cocaine-induced mood disorder
F14.288 Cocaine dependence with other cocaine-induced disorder
F14.921 Cocaine use, unspecified with intoxication delirium
F14.929 Cocaine use, unspecified with intoxication, unspecified
F14.94 Cocaine use, unspecified with cocaine-induced mood disorder
F14.988 Cocaine use, unspecified with other cocaine-induced disorder
F15.121 Other stimulant abuse with intoxication delirium
F15.129 Other stimulant abuse with intoxication, unspecified
F15.14 Other stimulant abuse with stimulant-induced mood disorder
F15.188 Other stimulant abuse with other stimulant-induced disorder
F15.221 Other stimulant dependence with intoxication delirium
F15.229 Other stimulant dependence with intoxication, unspecified
F15.24 Other stimulant dependence with stimulant-induced mood disorder
Data Source: Local Coverage Determination (LCD): Heavy Metal Testing (L35074)
10/01/16
F15.288 Other stimulant dependence with other stimulant-induced disorder
F15.921 Other stimulant use, unspecified with intoxication delirium
F15.929 Other stimulant use, unspecified with intoxication, unspecified
F15.94 Other stimulant use, unspecified with stimulant-induced mood disorder
F15.988 Other stimulant use, unspecified with other stimulant-induced disorder
F16.121 Hallucinogen abuse with intoxication with delirium
F16.129 Hallucinogen abuse with intoxication, unspecified
F16.14 Hallucinogen abuse with hallucinogen-induced mood disorder
F16.188 Hallucinogen abuse with other hallucinogen-induced disorder
F16.221 Hallucinogen dependence with intoxication with delirium
F16.229 Hallucinogen dependence with intoxication, unspecified
F16.24 Hallucinogen dependence with hallucinogen-induced mood disorder
F16.288 Hallucinogen dependence with other hallucinogen-induced disorder
F16.921 Hallucinogen use, unspecified with intoxication with delirium
F16.929 Hallucinogen use, unspecified with intoxication, unspecified
F16.94 Hallucinogen use, unspecified with hallucinogen-induced mood disorder
F16.988 Hallucinogen use, unspecified with other hallucinogen-induced disorder
F18.121 Inhalant abuse with intoxication delirium
F18.129 Inhalant abuse with intoxication, unspecified
F18.14 Inhalant abuse with inhalant-induced mood disorder
F18.17 Inhalant abuse with inhalant-induced dementia
F18.188 Inhalant abuse with other inhalant-induced disorder
F18.221 Inhalant dependence with intoxication delirium
F18.229 Inhalant dependence with intoxication, unspecified
F18.24 Inhalant dependence with inhalant-induced mood disorder
http://questnet1.qdx.com/index.hthttp://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=32965&ContrId=180&ver=8&ContrVer=1&CntrctrSelected=180*1&Cntrctr=180&name=National+Government+Services,+Inc.+(13102,+MAC+-+Part+B)&DocType=Active&LCntrctr=54*1|55*1|56*1|52*1|53*1|51*1|57*1|63*1|89*1|64*1|65*1|192*1|1*1|2*1|178*1|180*1|179*1|181*1|182*1|183*1|138*1&bc=AgACAAIAAAAAAA==&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=6&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&DocType=Future&LCntrctr=299*1&bc=AgACAAIAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&
Last Updated:
This list was compiled from Medicares Limited Coverage Policies for informational and reference purposes only. For the most current information please reference www.cms.gov.
Note: If the patients medical record does not support one of the above ICD-10-CM codes, please prepare an Advance Beneficiary Notice form, and ask the patient to read and sign it.
Source: Federal Registry Negotiated Rule-making, November 23, 2001
The cpt codes provided are based on ama guidelines and are for informational purposes only. Cpt coding is the sole responsibility of the billing party.
Please direct any questions regarding coding to the payer being billed.
Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics.
All third party marks - and - are the property of their respective owners. 2016 Quest Diagnostics Incorporated. All rights reserved
Medicare Local Coverage Determination Policy- CT, MA, ME, NH, RI, VT
Heavy Metal Testing (pg. 3 of 10) CPT Codes: 82108, 82175, 82300, 82495, 82525, 83018,
83655, 83785, 83825, 83885, 84255, 84285, 84630
LCD Description: The term heavy metal testing is historically used to describe elements such as lead, arsenic, mercury, cadmium, and chromium. In general, all of the heavy
metals in inorganic form cause GI irritation, resulting in nausea, vomiting, abdominal pain and diarrhea. The next most consistent toxicity for the heavy metals as a group, but not
for every heavy metal, is renal toxicity. A further generalization is that each member of the heavy metal group tends to cause multi-organ toxicity. Many metals cause cutaneous
abnormalities, such as irritant and allergic contact dermatitis, urticaria, keratoses, and premalignant and malignant lesions. Several of the heavy metals produce central and
peripheral nervous system toxicity. Other metals cause pulmonary illness. However, before any testing for heavy metal is ordered, a detailed medical history of the patient must
be obtained, including a careful documentation of occupational and avocational exposure to these toxins. A complete physical examination must be done. While classified as
heavy metals, this policy does not include iron or lithium since the former is typically tested for anemia issues and the latter is typically tested for monitoring of medications. In
addition, iron testing is covered under the National Coverage Determination 190.18 (Serum Iron Studies).
ICD-10-CM Codes that Support Medical Necessity are listed, but it is not enough to link the procedure code to a correct payable ICD-10-CM code. The diagnosis must
be present for the procedure to be paid and the procedure must be reasonable and medically necessary for that diagnosis. Documentation within the patients medical record
must support the medical necessity for the test(s) provided. This list was compiled from the Medicare Local Coverage Determination Policy. An ICD-10-CM book should be
used as a complete reference.
F18.27 Inhalant dependence with inhalant-induced dementia
F18.288 Inhalant dependence with other inhalant-induced disorder
F18.921 Inhalant use, unspecified with intoxication with delirium
F18.929 Inhalant use, unspecified with intoxication, unspecified
F18.94 Inhalant use, unspecified with inhalant-induced mood disorder
F18.97 Inhalant use, unspecified with inhalant-induced persisting dementia
F18.988 Inhalant use, unspecified with other inhalant-induced disorder
F19.121 Other psychoactive substance abuse with intoxication delirium
F19.129 Other psychoactive substance abuse with intoxication, unspecified
F19.14 Other psychoactive substance abuse with psychoactive substance-
induced mood disorder
F19.16 Other psychoactive substance abuse with psychoactive substance-
induced persisting amnestic disorder
F19.17 Other psychoactive substance abuse with psychoactive substance-
induced persisting dementia
F19.188 Other psychoactive substance abuse with other psychoactive substance-
induced disorder
F19.221 Other psychoactive substance dependence with intoxication delirium
F19.229 Other psychoactive substance dependence with intoxication, unspecified
F19.24 Other psychoactive substance dependence with psychoactive
substance- induced mood disorder
F19.26 Other psychoactive substance dependence with psychoactive substance-
induced persisting amnestic disorder
F19.27 Other psychoactive substance dependence with psychoactive substance-
induced persisting dementia
Data Source: Local Coverage Determination (LCD): Heavy Metal Testing (L35074)
10/01/16
F19.288 Other psychoactive substance dependence with other psychoactive
substance-induced disorder
F19.921 Other psychoactive substance use, unspecified with intoxication with delirium
F19.929 Other psychoactive substance use, unspecified with intoxication, unspecified
F19.94 Other psychoactive substance use, unspecified with psychoactive substance-
induced mood disorder
F19.96 Other psychoactive substance use, unspecified with psychoactive substance-
Induced persisting amnestic disorder
F19.97 Other psychoactive substance use, unspecified with psychoactive substance-
induced persisting dementia
F19.988 Other psychoactive substance use, unspecified with other psychoactive
substance-induced disorder
N18.1 Chronic kidney disease, stage 1
N18.2 Chronic kidney disease, stage 2 (mild)
N18.3 Chronic kidney disease, stage 3 (moderate)
N18.4 Chronic kidney disease, stage 4 (severe)
N18.5 Chronic kidney disease, stage 5
N18.6 End stage renal disease
N18.9 Chronic kidney disease, unspecified
T47.0X4A Poisoning by histamine H2-receptor blockers, undetermined, initial
encounter
T47.0X4D Poisoning by histamine H2-receptor blockers, undetermined, subsequent
encounter
T47.0X4S Poisoning by histamine H2-receptor blockers, undetermined, sequela
T47.1X4A Poisoning by other antacids and anti-gastric-secretion drugs,
undetermined, initial encounter
http://questnet1.qdx.com/index.hthttp://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=32965&ContrId=180&ver=8&ContrVer=1&CntrctrSelected=180*1&Cntrctr=180&name=National+Government+Services,+Inc.+(13102,+MAC+-+Part+B)&DocType=Active&LCntrctr=54*1|55*1|56*1|52*1|53*1|51*1|57*1|63*1|89*1|64*1|65*1|192*1|1*1|2*1|178*1|180*1|179*1|181*1|182*1|183*1|138*1&bc=AgACAAIAAAAAAA==&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&
Last Updated:
This list was compiled from Medicares Limited Coverage Policies for informational and reference purposes only. For the most current information please reference www.cms.gov.
Note: If the patients medical record does not support one of the above ICD-10-CM codes, please prepare an Advance Beneficiary Notice form, and ask the patient to read and sign it.
Source: Federal Registry Negotiated Rule-making, November 23, 2001
The cpt codes provided are based on ama guidelines and are for informational purposes only. Cpt coding is the sole responsibility of the billing party.
Please direct any questions regarding coding to the payer being billed.
Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics.
All third party marks - and - are the property of their respective owners. 2016 Quest Diagnostics Incorporated. All rights reserved
Medicare Local Coverage Determination Policy- CT, MA, ME, NH, RI, VT
Heavy Metal Testing (pg. 4 of 10) CPT Codes: 82108, 82175, 82300, 82495, 82525, 83018,
83655, 83785, 83825, 83885, 84255, 84285, 84630
LCD Description: The term heavy metal testing is historically used to describe elements such as lead, arsenic, mercury, cadmium, and chromium. In general, all of the heavy
metals in inorganic form cause GI irritation, resulting in nausea, vomiting, abdominal pain and diarrhea. The next most consistent toxicity for the heavy metals as a group, but not
for every heavy metal, is renal toxicity. A further generalization is that each member of the heavy metal group tends to cause multi-organ toxicity. Many metals cause cutaneous
abnormalities, such as irritant and allergic contact dermatitis, urticaria, keratoses, and premalignant and malignant lesions. Several of the heavy metals produce central and
peripheral nervous system toxicity. Other metals cause pulmonary illness. However, before any testing for heavy metal is ordered, a detailed medical history of the patient must
be obtained, including a careful documentation of occupational and avocational exposure to these toxins. A complete physical examination must be done. While classified as
heavy metals, this policy does not include iron or lithium since the former is typically tested for anemia issues and the latter is typically tested for monitoring of medications. In
addition, iron testing is covered under the National Coverage Determination 190.18 (Serum Iron Studies).
ICD-10-CM Codes that Support Medical Necessity are listed, but it is not enough to link the procedure code to a correct payable ICD-10-CM code. The diagnosis must
be present for the procedure to be paid and the procedure must be reasonable and medically necessary for that diagnosis. Documentation within the patients medical record
must support the medical necessity for the test(s) provided. This list was compiled from the Medicare Local Coverage Determination Policy. An ICD-10-CM book should be
used as a complete reference.
T47.1X4D Poisoning by other antacids and anti-gastric-secretion drugs,
undetermined, subsequent encounter
T47.1X4S Poisoning by other antacids and anti-gastric-secretion drugs,
undetermined, sequela
T56.894A Toxic effect of other metals, undetermined, initial encounter
T56.894D Toxic effect of other metals, undetermined, subsequent encounter
T56.894S Toxic effect of other metals, undetermined, sequela
T82.898A Other specified complication of vascular prosthetic devices, implants
and grafts, initial encounter
T82.898D Other specified complication of vascular prosthetic devices, implants
and grafts, subsequent encounter
T82.898S Other specified complication of vascular prosthetic devices, implants
and grafts, sequela
CPT 83018 , Antimony- Serum and/or urine antimony testing is payable for
beneficiaries with documented treatment in the past with antileishmaniasis
agents or with documented chronic antimony industrial exposure history.
B55.9 Leishmaniasis, unspecified
T56.891A Toxic effect of other metals, accidental (unintentional), initial encounter
T56.891D Toxic effect of other metals, accidental (unintentional), subsequent
encounter
T56.891S Toxic effect of other metals, accidental (unintentional), sequela
Data Source: Local Coverage Determination (LCD): Heavy Metal Testing (L35074)
10/01/16
CPT 82175 , Arsenic- Serum and whole blood and/or urine arsenic testing is
payable for beneficiaries with unexplained peripheral neuropathies, industrial
exposure to arsenic, histories of arsenic pesticide exposure, unexplained
encephalopathies, unexplained weight loss, chronic glomerulonephritis, bone
marrow hypoplasia, or melanosis of skin, unexplained chronic diarrhea,
persistent abdominal pain, or nausea and vomiting.
D61.1 Drug-induced aplastic anemia
D61.2 Aplastic anemia due to other external agents
D61.3 Idiopathic aplastic anemia
D61.89 Other specified aplastic anemias and other bone marrow failure syndromes
G60.0 Hereditary motor and sensory neuropathy
G60.2 Neuropathy in association with hereditary ataxia
G60.9 Hereditary and idiopathic neuropathy, unspecified
G61.1 Serum neuropathy
G62.2 Polyneuropathy due to other toxic agents
G62.82 Radiation-induced polyneuropathy
G93.40 Encephalopathy, unspecified
G93.41 Metabolic encephalopathy
G93.49 Other encephalopathy
I67.83 Posterior reversible encephalopathy syndrome
K52.21 Food protein-induced enterocolitis syndrome
K52.22 Food protein-induced enteropathy
K52.29 Other allergic and dietetic gastroenteritis and colitis
K52.89 Other specified noninfective gastroenteritis and colitis
K63.4 Enteroptosis
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Last Updated:
This list was compiled from Medicares Limited Coverage Policies for informational and reference purposes only. For the most current information please reference www.cms.gov.
Note: If the patients medical record does not support one of the above ICD-10-CM codes, please prepare an Advance Beneficiary Notice form, and ask the patient to read and sign it.
Source: Federal Registry Negotiated Rule-making, November 23, 2001
The cpt codes provided are based on ama guidelines and are for informational purposes only. Cpt coding is the sole responsibility of the billing party.
Please direct any questions regarding coding to the payer being billed.
Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics.
All third party marks - and - are the property of their respective owners. 2016 Quest Diagnostics Incorporated. All rights reserved
Medicare Local Coverage Determination Policy- CT, MA, ME, NH, RI, VT
Heavy Metal Testing (pg. 5 of 10) CPT Codes: 82108, 82175, 82300, 82495, 82525, 83018,
83655, 83785, 83825, 83885, 84255, 84285, 84630
LCD Description: The term heavy metal testing is historically used to describe elements such as lead, arsenic, mercury, cadmium, and chromium. In general, all of the heavy
metals in inorganic form cause GI irritation, resulting in nausea, vomiting, abdominal pain and diarrhea. The next most consistent toxicity for the heavy metals as a group, but not
for every heavy metal, is renal toxicity. A further generalization is that each member of the heavy metal group tends to cause multi-organ toxicity. Many metals cause cutaneous
abnormalities, such as irritant and allergic contact dermatitis, urticaria, keratoses, and premalignant and malignant lesions. Several of the heavy metals produce central and
peripheral nervous system toxicity. Other metals cause pulmonary illness. However, before any testing for heavy metal is ordered, a detailed medical history of the patient must
be obtained, including a careful documentation of occupational and avocational exposure to these toxins. A complete physical examination must be done. While classified as
heavy metals, this policy does not include iron or lithium since the former is typically tested for anemia issues and the latter is typically tested for monitoring of medications. In
addition, iron testing is covered under the National Coverage Determination 190.18 (Serum Iron Studies).
ICD-10-CM Codes that Support Medical Necessity are listed, but it is not enough to link the procedure code to a correct payable ICD-10-CM code. The diagnosis must
be present for the procedure to be paid and the procedure must be reasonable and medically necessary for that diagnosis. Documentation within the patients medical record
must support the medical necessity for the test(s) provided. This list was compiled from the Medicare Local Coverage Determination Policy. An ICD-10-CM book should be
used as a complete reference.
K63.89 Other specified diseases of intestine
K92.89 Other specified diseases of the digestive system
L23.1 Allergic contact dermatitis due to adhesives
L23.5 Allergic contact dermatitis due to other chemical products
L24.5 Irritant contact dermatitis due to other chemical products
L25.3 Unspecified contact dermatitis due to other chemical products
N03.9 Chronic nephritic syndrome with unspecified morphologic changes
R11.2 Nausea with vomiting, unspecified
R19.7 Diarrhea, unspecified
R63.4 Abnormal weight loss
T57.0X4A Toxic effect of arsenic and its compounds, undetermined, initial
encounter
T57.0X4D Toxic effect of arsenic and its compounds, undetermined, subsequent
encounter
T57.0X4S Toxic effect of arsenic and its compounds, undetermined, sequela
CPT 83018, Barium- Serum and or/urine barium testing is payable for
beneficiaries with pulmonary disease with industrial exposure to barium or
unexplained flaccid paralysis.
J98.4 Other disorders of lung
T56.894A Toxic effect of other metals, undetermined, initial encounter
T56.894D Toxic effect of other metals, undetermined, subsequent encounter
T56.894S Toxic effect of other metals, undetermined, sequela
Data Source: Local Coverage Determination (LCD): Heavy Metal Testing (L35074)
10/01/16
CPT 83018: Beryllium- Serum and/or urine beryllium testing is payable for
beneficiaries with pulmonary disease with industrial exposure to beryllium.
J98.4 Other disorders of lung
T56.7X4A Toxic effect of beryllium and its compounds, undetermined, initial
encounter
T56.7X4D Toxic effect of beryllium and its compounds, undetermined,
subsequent encounter
T56.7X4S Toxic effect of beryllium and its compounds, undetermined, sequela
CPT 83018: Bismuth- Serum and/or urine bismuth testing is payable for
beneficiaries with bismuth lines on their gums, methemoglobinemia,
unexplained pathological fractures, or a history of bismuth medicine abuse.
D74.8 Other methemoglobinemias
D74.9 Methemoglobinemia, unspecified
K05.5 Other periodontal diseases
M84.40XA Pathological fracture, unspecified site, initial encounter for fracture
M84.40XD Pathological fracture, unspecified site, subsequent encounter for
fracture with routine healing
M84.40XS Pathological fracture, unspecified site, sequela
T56.894A Toxic effect of other metals, undetermined, initial encounter
T56.894D Toxic effect of other metals, undetermined, subsequent encounter
T56.894S Toxic effect of other metals, undetermined, sequela
http://questnet1.qdx.com/index.hthttp://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=32965&ContrId=180&ver=8&ContrVer=1&CntrctrSelected=180*1&Cntrctr=180&name=National+Government+Services,+Inc.+(13102,+MAC+-+Part+B)&DocType=Active&LCntrctr=54*1|55*1|56*1|52*1|53*1|51*1|57*1|63*1|89*1|64*1|65*1|192*1|1*1|2*1|178*1|180*1|179*1|181*1|182*1|183*1|138*1&bc=AgACAAIAAAAAAA==&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&
Last Updated:
This list was compiled from Medicares Limited Coverage Policies for informational and reference purposes only. For the most current information please reference www.cms.gov.
Note: If the patients medical record does not support one of the above ICD-10-CM codes, please prepare an Advance Beneficiary Notice form, and ask the patient to read and sign it.
Source: Federal Registry Negotiated Rule-making, November 23, 2001
The cpt codes provided are based on ama guidelines and are for informational purposes only. Cpt coding is the sole responsibility of the billing party.
Please direct any questions regarding coding to the payer being billed.
Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics.
All third party marks - and - are the property of their respective owners. 2016 Quest Diagnostics Incorporated. All rights reserved
Medicare Local Coverage Determination Policy- CT, MA, ME, NH, RI, VT
Heavy Metal Testing (pg . 6 of 10) CPT Codes: 82108, 82175, 82300, 82495, 82525, 83018,
83655, 83785, 83825, 83885, 84255, 84285, 84630
LCD Description: The term heavy metal testing is historically used to describe elements such as lead, arsenic, mercury, cadmium, and chromium. In general, all of the heavy
metals in inorganic form cause GI irritation, resulting in nausea, vomiting, abdominal pain and diarrhea. The next most consistent toxicity for the heavy metals as a group, but not
for every heavy metal, is renal toxicity. A further generalization is that each member of the heavy metal group tends to cause multi-organ toxicity. Many metals cause cutaneous
abnormalities, such as irritant and allergic contact dermatitis, urticaria, keratoses, and premalignant and malignant lesions. Several of the heavy metals produce central and
peripheral nervous system toxicity. Other metals cause pulmonary illness. However, before any testing for heavy metal is ordered, a detailed medical history of the patient must
be obtained, including a careful documentation of occupational and avocational exposure to these toxins. A complete physical examination must be done. While classified as
heavy metals, this policy does not include iron or lithium since the former is typically tested for anemia issues and the latter is typically tested for monitoring of medications. In
addition, iron testing is covered under the National Coverage Determination 190.18 (Serum Iron Studies).
ICD-10-CM Codes that Support Medical Necessity are listed, but it is not enough to link the procedure code to a correct payable ICD-10-CM code. The diagnosis must
be present for the procedure to be paid and the procedure must be reasonable and medically necessary for that diagnosis. Documentation within the patients medical record
must support the medical necessity for the test(s) provided. This list was compiled from the Medicare Local Coverage Determination Policy. An ICD-10-CM book should be
used as a complete reference.
CPT 82300, Cadmium- Cadmium. Serum and whole blood and/or urine
cadmium testing is payable for beneficiaries with an exposure to cadmium
with evidence of pulmonary disease or unexplained renal failure.
J98.4 Other disorders of lung
N19 Unspecified kidney failure
T56.3X4A Toxic effect of cadmium and its compounds, undetermined, initial
encounter
T56.3X4D Toxic effect of cadmium and its compounds, undetermined,
subsequent encounter
T56.3X4S Toxic effect of cadmium and its compounds, undetermined, sequela
CPT 82495, Chromium.- Serum chromium testing is payable for beneficiaries
with an industrial exposure to chromium with evidence of pulmonary
disease.
J98.4 Other disorders of lung
T56.2X4A Toxic effect of chromium and its compounds, undetermined, initial
encounter
T56.2X4D Toxic effect of chromium and its compounds, undetermined,
subsequent encounter
T56.2X4S Toxic effect of chromium and its compounds, undetermined, sequela
Data Source: Local Coverage Determination (LCD): Heavy Metal Testing (L35074)
10/01/16
CPT 83018: Cobalt. Serum cobalt testing is payable for beneficiaries with an
industrial exposure to cobalt with evidence of pulmonary disease
J98.4 Other disorders of lung
T56.894A Toxic effect of other metals, undetermined, initial encounter
T56.894D Toxic effect of other metals, undetermined, subsequent encounter
T56.894S Toxic effect of other metals, undetermined, sequela
CPT 82525: Copper. Serum copper testing is payable for beneficiaries with an
industrial exposure to copper with evidence of pulmonary disease, or for
beneficiaries with Wilsons Disease, unexplained cardiomyopathy, unexplained
renal failure, polycythemia. unexplained myelodysplastic syndrome or known
ingestion of zinc.
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.20 Refractory anemia with excess of blasts, unspecified
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.4 Refractory anemia, unspecified
D46.Z Other myelodysplastic syndromes
D46.9 Myelodysplastic syndrome, unspecified
http://questnet1.qdx.com/index.hthttp://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=32965&ContrId=180&ver=8&ContrVer=1&CntrctrSelected=180*1&Cntrctr=180&name=National+Government+Services,+Inc.+(13102,+MAC+-+Part+B)&DocType=Active&LCntrctr=54*1|55*1|56*1|52*1|53*1|51*1|57*1|63*1|89*1|64*1|65*1|192*1|1*1|2*1|178*1|180*1|179*1|181*1|182*1|183*1|138*1&bc=AgACAAIAAAAAAA==&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&
Last Updated:
This list was compiled from Medicares Limited Coverage Policies for informational and reference purposes only. For the most current information please reference www.cms.gov.
Note: If the patients medical record does not support one of the above ICD-10-CM codes, please prepare an Advance Beneficiary Notice form, and ask the patient to read and sign it.
Source: Federal Registry Negotiated Rule-making, November 23, 2001
The cpt codes provided are based on ama guidelines and are for informational purposes only. Cpt coding is the sole responsibility of the billing party.
Please direct any questions regarding coding to the payer being billed.
Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics.
All third party marks - and - are the property of their respective owners. 2016 Quest Diagnostics Incorporated. All rights reserved
Medicare Local Coverage Determination Policy- CT, MA, ME, NH, RI, VT
Heavy Metal Testing (pg. 7 of 10) CPT Codes: 82108, 82175, 82300, 82495, 82525, 83018,
83655, 83785, 83825, 83885, 84255, 84285, 84630
LCD Description: The term heavy metal testing is historically used to describe elements such as lead, arsenic, mercury, cadmium, and chromium. In general, all of the heavy
metals in inorganic form cause GI irritation, resulting in nausea, vomiting, abdominal pain and diarrhea. The next most consistent toxicity for the heavy metals as a group, but not
for every heavy metal, is renal toxicity. A further generalization is that each member of the heavy metal group tends to cause multi-organ toxicity. Many metals cause cutaneous
abnormalities, such as irritant and allergic contact dermatitis, urticaria, keratoses, and premalignant and malignant lesions. Several of the heavy metals produce central and
peripheral nervous system toxicity. Other metals cause pulmonary illness. However, before any testing for heavy metal is ordered, a detailed medical history of the patient must
be obtained, including a careful documentation of occupational and avocational exposure to these toxins. A complete physical examination must be done. While classified as
heavy metals, this policy does not include iron or lithium since the former is typically tested for anemia issues and the latter is typically tested for monitoring of medications. In
addition, iron testing is covered under the National Coverage Determination 190.18 (Serum Iron Studies).
ICD-10-CM Codes that Support Medical Necessity are listed, but it is not enough to link the procedure code to a correct payable ICD-10-CM code. The diagnosis must
be present for the procedure to be paid and the procedure must be reasonable and medically necessary for that diagnosis. Documentation within the patients medical record
must support the medical necessity for the test(s) provided. This list was compiled from the Medicare Local Coverage Determination Policy. An ICD-10-CM book should be
used as a complete reference.
E83.00 Disorder of copper metabolism, unspecified
E83.09 Other disorders of copper metabolism
I42.9 Cardiomyopathy, unspecified
J98.4 Other disorders of lung
K73.0 Chronic persistent hepatitis, not elsewhere classified
K73.9 Chronic hepatitis, unspecified
K74.60 Unspecified cirrhosis of liver
K74.69 Other cirrhosis of liver
K76.9 Liver disease, unspecified
N19 Unspecified kidney failure
Q89.8 Other specified congenital malformations
R63.3 Feeding difficulties
R74.8 Abnormal levels of other serum enzymes
R74.9 Abnormal serum enzyme level, unspecified
T56.894A Toxic effect of other metals, undetermined, initial encounter
T56.894D Toxic effect of other metals, undetermined, subsequent encounter
T56.894S Toxic effect of other metals, undetermined, sequela
CPT 83655: Lead. Blood (serum and whole) and/or urine lead testing is
covered if there is documented industrial exposure to lead, documented
avocation exposure to lead, retained bullet fragments at or near joints, a blue
gum line, a history of moonshine abuse, unexplained peripheral
neuropathies, evidence of lead contaminated drinking water, paint stripping,
lead lines on bones on radiographs, or basophilic stippling of red blood cells.
Data Source: Local Coverage Determination (LCD): Heavy Metal Testing (L35074)
10/01/16
G58.8 Other specified mononeuropathies
G58.9 Mononeuropathy, unspecified
G60.0 Hereditary motor and sensory neuropathy
G60.1 Refsum's disease
G60.2 Neuropathy in association with hereditary ataxia
G60.3 Idiopathic progressive neuropathy
G60.8 Other hereditary and idiopathic neuropathies
G60.9 Hereditary and idiopathic neuropathy, unspecified
G93.40 Encephalopathy, unspecified
G93.41 Metabolic encephalopathy
G93.49 Other encephalopathy
R71.0 Precipitous drop in hematocrit
R71.8 Other abnormality of red blood cells
R93.6 Abnormal findings on diagnostic imaging of limbs
R93.7 Abnormal findings on diagnostic imaging of other parts of
musculoskeletal system
T56.0X4A Toxic effect of lead and its compounds, undetermined, initial encounter
T56.0X4D Toxic effect of lead and its compounds, undetermined, subsequent
encounter
T56.0X4S Toxic effect of lead and its compounds, undetermined, sequela
CPT 83785, Manganese- Serum manganese testing is covered for beneficiaries
with documented industrial exposure to manganese.
G25.70 Drug induced movement disorder, unspecified
G25.71 Drug induced akathisia
http://questnet1.qdx.com/index.hthttp://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=32965&ContrId=180&ver=8&ContrVer=1&CntrctrSelected=180*1&Cntrctr=180&name=National+Government+Services,+Inc.+(13102,+MAC+-+Part+B)&DocType=Active&LCntrctr=54*1|55*1|56*1|52*1|53*1|51*1|57*1|63*1|89*1|64*1|65*1|192*1|1*1|2*1|178*1|180*1|179*1|181*1|182*1|183*1|138*1&bc=AgACAAIAAAAAAA==&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35074&ContrId=299&ver=9&ContrVer=1&CntrctrSelected=299*1&Cntrctr=299&name=National+Government+Services,+Inc.+(National+Government+Services,+Inc.+(13102,+A+and+B+and+HHH+MAC,+J+-+K))&LCntrctr=299*1&DocType=Active&bc=AgACAAQAAAAAAA%3d%3d&
Last Updated:
This list was compiled from Medicares Limited Coverage Policies for informational and reference purposes only. For the most current information please reference www.cms.gov.
Note: If the patients medical record does not support one of the above ICD-10-CM codes, please prepare an Advance Beneficiary Notice form, and ask the patient to read and sign it.
Source: Federal Registry Negotiated Rule-making, November 23, 2001
The cpt codes provided are based on ama guidelines and are for informational purposes only. Cpt coding is the sole responsibility of the billing party.
Please direct any questions regarding coding to the payer being billed.
Quest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics.
All third party marks - and - are the property of their respective owners. 2016 Quest Diagnostics Incorporated. All rights reserved
Medicare Local Coverage Determination Policy- CT, MA, ME, NH, RI, VT
Heavy Metal Testing (pg. 8 of 10) CPT Codes: 82108, 82175, 82300, 82495, 82525, 83018,
83655, 83785, 83825, 83885, 84255, 84285, 84630
LCD Description: The term heavy metal testing is historically used to describe elements such as lead, arsenic, mercury, cadmium, and chromium. In general, all of the heavy
metals in inorganic form cause GI irritation, resulting in nausea, vomiting, abdominal pain and diarrhea. The next most consistent toxicity for the heavy metals as a group, but not
for every heavy metal, is renal toxicity. A further generalization is that each member of the heavy metal group tends to cause multi-organ toxicity. Many metals cause cutaneous
abnormalities, such as irritant and allergic contact dermatitis, urticaria, keratoses, and premalignant and malignant lesions. Several of the heavy metals produce central and
peripheral nervous system toxicity. Other metals cause pulmonary illness. However, before any testing for heavy metal is ordered, a detailed medical history of the patient must
be obtained, including a careful documentation of occupational and avocational exposure to these toxins. A complete physical examination must be done. While classified as
heavy metals, this policy does not include iron or lithium since the former is typically tested for anemia issues and the latter is typically tested for monitoring of medications. In
addition, iron testing is covered under the National Coverage Determination 190.18 (Serum Iron Studies).
ICD-10-CM Codes that Support Medical Necessity are listed, but it is not enough to link the procedure code to a correct payable ICD-10-CM code. The diagnosis must
be present for the procedure to be paid and the procedure must be reasonable and medically necessary for that diagnosis. Documentation within the patients medical record
must support the medical necessity for the test(s) provided. This list was compiled from the Medicare Local Coverage Determination Policy. An ICD-10-CM book should be
used as a complete reference.
G25.79 Other drug induced movement disorders
G25.89 Other specified extrapyramidal and movement disorders
G25.9 Extrapyramidal and movement disorder, unspecified
G26 Extrapyramidal and movement disorders in diseases classified
elsewhere
R63.3 Feeding difficulties
T57.2X4A Toxic effect of manganese and its compounds, undetermined, initial
encounter
T57.2X4D Toxic effect of manganese and its compounds, undetermined,
subsequent encounter
T57.2X4S Toxic effect of manganese and its compounds, undetermined, sequela
CPT 83825, Mercury- Serum, whole blood, and/or urine mercury testing is
covered for beneficiaries with documented industrial exposure to mercury,
with a blue line in their mouth, those with a history of laxative abuse, with a
history of pesticide exposure, mercury spillage with vacuuming of the liquid
metal, unexplained renal failure, or a history of skin lightening treatments.
G11.1 Early-onset cerebellar ataxia
G25.70 Drug induced movement disorder, unspecified
G25.71 Drug induced akathisia
G25.79 Other drug induced movement disorders
G25.89 Other specified extrapyramidal and movement disorders
G25.9 Extrapyramidal and movement disorder, unspecified
G26 Extrapyramidal and movement disorders in diseases classified elsewhere
I69.093 Ataxia following nontraumatic subarachnoid hemorrhage
Data Source: Local Coverage Determination (LCD): Heavy Metal Testing (L35074)
10/01/16
I69.193 Ataxia following nontraumatic intracerebral hemorrhage
I69.293 Ataxia following other nontraumatic intracranial hemorrhage
I69.393 Ataxia following cerebral infarction
I69.893 Ataxia following other cerebrovascular disease
I69.993 Ataxia following unspecified cerebrovascular disease
N19 Unspecified kidney failure
R27.0 Ataxia, unspecified
R27.8 Other lack of coordination
R27.9 Unspecified lack of coordination
T37.8X1A Poisoning by other specified systemic anti-infectives and antiparasitics,
accidental (unintentional), initial encounter
T37.8X1D Poisoning by other specified systemic anti-infectives and antiparasitics,
accidental (unintentional), subsequent encounter
T37.8X1S Poisoning by other specified systemic anti-infectives and antiparasitics,
accidental (unintentional), sequela
T47.4X4A Poisoning by other laxatives, undetermined, initial encounter
T47.4X4D Poisoning by other laxatives, undetermined, subsequent encounter
T47.4X4S Poisoning by other laxatives, undetermined, sequela
T49.8X4A Poisoning by other topical agents, undetermined, initial encounter
T49.8X4D Poisoning by other topical agents, undetermined, subsequent encounter
T49.8X4S Poisoning by other topical agents, undetermined, sequela
T56.1X4A Toxic effect of mercury and its compounds, undetermined, initial
encounter
T56.1X4D Toxic effect of mercury and its compounds, undetermined, subsequent
encounter
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