Effective July 1, 2019, BlueCross® BlueShield® of South Carolina and BlueChoice HealthPlan will implement a new medical policy addressing the criteria for coverage of parathyroid hormone (PTH), phosphorus, calcium and magnesium testing, CAM 217 – Parathyroid Hormone, Phosphorus, Calcium and Magnesium Testing. Claims with procedure codes associated with these laboratory tests will be reviewed by our Avalon claim editing technology to ensure consistent application of the medical policy. Avalon is an independent company that provides laboratory benefits management services on behalf of BlueCross and BlueChoice®. As a reminder, continue to use in-network laboratories to make sure your patients are receiving the highest quality of care at the lowest out-of-pocket cost and all ordered lab tests are within our policy guidelines.
A portion of the new medical policy reads:
- Serum intact PTH testing is considered medically necessary in the following situations:
- - to assess possible hyperthyroidism.
- - to assess post-operative results of parathyroid surgery.
- - as part of annual testing of a patient previously diagnosed with hyperparathyroidism.
- - as part of assessment of chronic kidney disease.
- - as a part of assessment of osteoporosis.
- - as a part of diagnosis and/or assessment of cancer or cancer therapy.
- Serum intact PTH testing is considered not medically necessary in screening of patients for asymptomatic hyperthyroidism.
- Testing serum for truncated parathyroid hormone metabolites, including amino-terminal and carboxy-terminal fragments is considered investigational.
Below are the procedure codes listed in the coding section of the medical policy. These codes are included in the medical policy as a general reference tool and may not be all-inclusive:
||Calcium; urine quantitative, timed specimen
||Parathormone (parathyroid hormone)
||Phosphorus inorganic (phosphate)
||Phosphorus inorganic (phosphate); urine
For complete information about CAM 217, visit our Medical Policies page. Please remember medical necessity is not a guarantee of payment. Payment is subject to the member’s plan coverage, to include prior authorization requirements and benefits at the time the service is performed. You may contact Provider Education by using the Provider Education Contact Form or by calling 803-264-4730 with additional questions.
BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association.