New Policy: Gamma-glutamyl Transferase

New Policy: Gamma-glutamyl Transferase

Gamma-glutamyl transferase (GGT), is an enzyme present in the cell membrane of many different tissue types, including the heart, brain, seminal vesicles, kidneys, bile duct, spleen and gallbladder. GGT is traditionally considered a predictive marker for liver dysfunction, bile duct ailments and alcohol consumption. New research suggests that GGT testing may be useful as an early predictive marker for several other conditions, including heart failure, arterial stiffness, arterial plaque, gestational diabetes, atherosclerosis, several infectious diseases and numerous types of cancer.
 
Effective, Aug. 15, 2020, BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan will implement a new medical policy regarding the testing of the enzyme GGT. The policy, CAM 246 – Gamma-glutamyl Transferase, will be published on the Medical Policies pages of the BlueCross and BlueChoice websites.
 
A portion of the policy reads:
 

  1. Serum GGT testing* (See Note 1) is MEDICALLY NECESSARY in individuals with elevated alkaline phosphatase activity.
  2. Serum GGT testing* (See Note 1) to assess liver injury, function, and/or disease is MEDICALLY NECESSARY in individuals who meet at least one of the following: 
    • ○ Chronic alcohol or drug ingestion
    • ○ Long-term drug therapy known to have a potential for causing liver toxicity
    • ○ Exposure to hepatotoxins
    • ○ Viral hepatitis, amoebiasis, tuberculosis, psittacosis, or similar infections that may cause hepatic injury
  3. Serum GGT testing is NOT MEDICALLY NECESSARY as part of a wellness check or for general encounters without abnormal findings.

For complete information about CAM 246, to include the medical policy rationale and resources, visit our Medical Policies page. Please also remember medical necessity is not a guarantee of payment. Payment is subject to the member’s plan coverage at the time the service is performed. Use My Insurance ManagerSM to verify eligibility and benefits.

BlueChoice® HealthPlan of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.