American Samoa
Guam
Hawaii
Northern Mariana Islands
01212 - A and B MAC
American Samoa
Guam
Hawaii
Northern Mariana Islands
01311 - A and B MAC
Nevada
01312 - A and B MAC
Nevada
01911 - A and B MAC
American Samoa
California - Entire State
Guam
Hawaii
Nevada
Northern Mariana Islands
Article Information
Article ID Number: A57643 Status: A-Approved
Article Title: Billing and Coding: Lab: Cystatin C Measurement
Original Article Effective Date:
11/01/2019
Revision Effective Date:
06/09/2022
Article Text:
The information in this article contains billing, coding, or, other guidelines that complement the Local Coverage Determination (LCD) for Lab: Cystatin C Measurement policy L37616.
Documentation Requirements
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
The medical record documentation must support the medical necessity of the services as directed in this policy.
The laboratory or billing provider must have on file the physician requisition which sets forth the diagnosis or condition (ICD-10-CM code) that warrants the test(s).
Examples of documentation requirements of the ordering physician/non-physician practitioner (NPP) include, but are not limited to, history and physical or exam findings that support the decision making, problems/diagnoses, relevant data (e.g., lab testing).
Medical record documentation must support cystatin C test was performed on an adult patient with creatinine based eGFR 45–59 ml/min/1.73 m2 who does not have markers of kidney damage.
Medical record documentation must clearly indicate the rationale which supports the medical necessity for performing eGFR by measurement of cystatin C (i.e. support GFR estimates based on serum creatinine are thought to be inaccurate and what decisions depend on more accurate knowledge of the GFR) and must reflect how the test result were used in the patient’s plan of care.
To report a Cystatin C service, please submit the following claim information:
Select CPT® code 82610
Enter 1 unit of service (UOS)
Select the appropriate ICD-10-CM code
Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT®/HCPCS codes included in this article. Providers are reminded that not all CPT®/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT®/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04, Claims Processing Manual, for further guidance.
Coding Information
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12
Hospital Inpatient (Medicare Part B only)
13
Hospital Outpatient
14
Hospital - Laboratory Services Provided to Non-patients
22
Skilled Nursing - Inpatient (Medicare Part B only)
23
Skilled Nursing - Outpatient
71
Clinic - Rural Health
72
Clinic - Hospital Based or Independent Renal Dialysis Center
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
0300
Laboratory - General Classification
0301
Laboratory - Chemistry
0302
Laboratory - Immunology
0303
Laboratory - Renal Patient (Home)
0304
Laboratory - Non-Routine Dialysis
0305
Laboratory - Hematology
0306
Laboratory - Bacteriology & Microbiology
0307
Laboratory - Urology
0309
Laboratory - Other Laboratory
0310
Laboratory Pathology - General Classification
0311
Laboratory Pathology - Cytology
0312
Laboratory Pathology - Histology
0314
Laboratory Pathology - Biopsy
0319
Laboratory Pathology - Other Laboratory Pathology
CPT/HCPCS Codes:
Group 1 Paragraph:
N/A
Group 1 CPT Codes:
82610
CYSTATIN C
ICD-10 Codes That Are Covered
N/A
N18.30
Chronic kidney disease, stage 3 unspecified
N18.31
Chronic kidney disease, stage 3a
N18.32
Chronic kidney disease, stage 3b
T50.904A
Poisoning by unspecified drugs, medicaments and biological substances, undetermined, initial encounter
T50.904D
Poisoning by unspecified drugs, medicaments and biological substances, undetermined, subsequent encounter
T50.904S
Poisoning by unspecified drugs, medicaments and biological substances, undetermined, sequela
T50.905A
Adverse effect of unspecified drugs, medicaments and biological substances, initial encounter
T50.905D
Adverse effect of unspecified drugs, medicaments and biological substances, subsequent encounter
T50.905S
Adverse effect of unspecified drugs, medicaments and biological substances, sequela
T50.994A
Poisoning by other drugs, medicaments and biological substances, undetermined, initial encounter
T50.994D
Poisoning by other drugs, medicaments and biological substances, undetermined, subsequent encounter
T50.994S
Poisoning by other drugs, medicaments and biological substances, undetermined, sequela
T50.995A
Adverse effect of other drugs, medicaments and biological substances, initial encounter
T50.995D
Adverse effect of other drugs, medicaments and biological substances, subsequent encounter
T50.995S
Adverse effect of other drugs, medicaments and biological substances, sequela
T65.94XA
Toxic effect of unspecified substance, undetermined, initial encounter
T65.94XD
Toxic effect of unspecified substance, undetermined, subsequent encounter
T65.94XS
Toxic effect of unspecified substance, undetermined, sequela
Z52.4
Kidney donor
ICD-10 Codes That Are Not Covered
N/A
Revision History Information
Revision History Date
Revision History Number
Revision History Explanation
06/09/2022
R4
Updated to indicate this article is an LCD Reference Article.
06/09/2022
R3
Under Article Title revised the title to read Billing and Coding: Lab: Cystatin C Measurement. Under Article Text revised title to Lab: Cystatin C Measurement. Formatting and punctuation were corrected throughout the article.
10/29/2020
R2
Under CMS National Coverage Policy added regulation CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.0, §80.1.1, and §80.1.2. Under Article Text added Documentation Requirements section and corresponding verbiage. Acronyms were inserted where appropriate throughout the article. Formatting, punctuation and typographical errors were corrected throughout the article.
10/01/2020
R1
Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added N18.30, N18.31, and N18.32 and deleted N18.3. This revision is due to the Annual ICD-10 Code Update and is effective on 10/1/20.
