New Medical Policy: Pancreatic Enzyme Testing for Acute Pancreatitis

New Medical Policy: Pancreatic Enzyme Testing for Acute Pancreatitis

6/22/18

Pancreatitis is an inflammation of pancreatic tissue and can be either acute or chronic. Damage to pancreatic tissue, including pancreatitis, can result in elevated pancreatic enzyme concentrations; whereas depressed enzyme levels are associated with exocrine pancreatic insufficiency.

Effective August 1, 2018, BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan will implement a new medical policy addressing the use of pancreatic enzymes to monitor the health of pancreatic tissue. The policy, CAM 198 – Pancreatic Enzyme Testing for Acute Pancreatitis, has been published on the Medical Policies pages of the BlueCross and BlueChoice websites.

A portion of the policy reads:

  1. Measurement of either serum lipase or amylase concentration for the initial  diagnosis of acute pancreatitis is considered medically necessary in all patients presenting signs and symptoms of acute pancreatitis. 
  2. Measurement of either serum lipase or amylase concentration is considered not medically necessary in the following situations: 
  • As part of an ongoing assessment of therapy for acute pancreatitis; or 
  • In determining the prognosis of pancreatitis; or 
  • In determining the severity or progression of pancreatitis; or 
  • More than once per visit; or
  • For the diagnosis, prognosis or severity of chronic pancreatitis; or 
  • As part of ongoing assessment or therapy of chronic pancreatitis  

For complete information about CAM 198, 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.


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