Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)


Related Local Coverage Determination (LCD)
L34914-Assays for Vitamins and Metabolic Function


Contractor NameContract NumberStates
Novitas Solutions, Inc. 04111 - A and B MAC Colorado
04112 - A and B MAC Colorado
04211 - A and B MAC New Mexico
04212 - A and B MAC New Mexico
04311 - A and B MAC Oklahoma
04312 - A and B MAC Oklahoma
04411 - A and B MAC Texas
04412 - A and B MAC Texas
04911 - A and B MAC Colorado
New Mexico
Oklahoma
Texas
07101 - A and B MAC Arkansas
07102 - A and B MAC Arkansas
07201 - A and B MAC Louisiana
07202 - A and B MAC Louisiana
07301 - A and B MAC Mississippi
07302 - A and B MAC Mississippi
12101 - A and B MAC Delaware
12102 - A and B MAC Delaware
12201 - A and B MAC District of Columbia
12202 - A and B MAC District of Columbia
12301 - A and B MAC Maryland
12302 - A and B MAC Maryland
12401 - A and B MAC New Jersey
12402 - A and B MAC New Jersey
12501 - A and B MAC Pennsylvania
12502 - A and B MAC Pennsylvania
12901 - A and B MAC Delaware
District of Columbia
Maryland
New Jersey
Pennsylvania

Article Information

Article ID Number: A56416 Status: A-Approved

Article Title: Billing and Coding: Assays for Vitamins and Metabolic Function

Original Article Effective Date: 03/28/2019

Revision Effective Date: 10/01/2021

Article Text:

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L34914, Assays for Vitamins and Metabolic Function. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

The following tests currently do not have specific codes assigned for the test.

  • CPT code 84999 should be used to bill the following tests and a note should be added to identify which test was performed in the Remarks area of the claim for Part A and the Narrative area of the claim for Part B:
    • Functional intracellular analysis
    • Total antioxidant function

Documentation Requirements

  1. All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
  2. 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.
  3. 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.

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.

12Hospital Inpatient (Medicare Part B only)
13Hospital Outpatient
14Hospital - Laboratory Services Provided to Non-patients
18Hospital - Swing Beds
21Skilled Nursing - Inpatient (Including Medicare Part A)
22Skilled Nursing - Inpatient (Medicare Part B only)
23Skilled Nursing - Outpatient
72Clinic - Hospital Based or Independent Renal Dialysis Center
75Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)
77Clinic - Federally Qualified Health Center (FQHC)
83Ambulatory Surgery Center
85Critical Access Hospital

Revenue Codes:

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

CPT/HCPCS Codes:

Group 1 Paragraph:

Note: The following CPT codes associated with the services outlined in this Billing and Coding Article will not have diagnosis code limitations applied at this time: 82180, 84252, 84425, 84446, 84590, 84597

Note:
Code 82306 includes fractions, if performed.
Code 82652 includes fractions, if performed.

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.



Group 1 CPT Codes:
82306 VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED
82652 VITAMIN D; 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED


Group 2 Paragraph:

N/A



Group 2 CPT Codes:
82379 CARNITINE (TOTAL AND FREE), QUANTITATIVE, EACH SPECIMEN


Group 3 Paragraph:

N/A



Group 3 CPT Codes:
82607 CYANOCOBALAMIN (VITAMIN B-12);
82746 FOLIC ACID; SERUM
83090 HOMOCYSTEINE


Group 4 Paragraph:

N/A



Group 4 CPT Codes:
84207 PYRIDOXAL PHOSPHATE (VITAMIN B-6)


Group 5 Paragraph:

N/A



Group 5 CPT Codes:
85385 FIBRINOGEN; ANTIGEN


Group 6 Paragraph:

N/A



Group 6 CPT Codes:
86352 CELLULAR FUNCTION ASSAY INVOLVING STIMULATION (EG, MITOGEN OR ANTIGEN) AND DETECTION OF BIOMARKER (EG, ATP)


Group 7 Paragraph:

N/A



Group 7 CPT Codes:
83698 LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 (LP-PLA2)


Group 8 Paragraph:

Note: The following CPT/HCPCS codes associated with the services outlined in this Billing and Coding Article will not have diagnosis limitations applied at this time. Refer to the related LCD for utilization guidelines.



Group 8 CPT Codes:
82180 ASCORBIC ACID (VITAMIN C), BLOOD
84252 RIBOFLAVIN (VITAMIN B-2)
84425 THIAMINE (VITAMIN B-1)
84446 TOCOPHEROL ALPHA (VITAMIN E)
84590 VITAMIN A
84597 VITAMIN K


ICD-10 Codes That Are Covered

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for (CPT/HCPCS) codes: 82306 and 82652

A15.0 Tuberculosis of lung
A15.4 Tuberculosis of intrathoracic lymph nodes
A15.5 Tuberculosis of larynx, trachea and bronchus
A15.6 Tuberculous pleurisy
A15.7 Primary respiratory tuberculosis
A15.8 Other respiratory tuberculosis
A15.9 Respiratory tuberculosis unspecified
A17.0 Tuberculous meningitis
A17.1 Meningeal tuberculoma
A17.81 Tuberculoma of brain and spinal cord
A17.82 Tuberculous meningoencephalitis
A17.83 Tuberculous neuritis
A17.89 Other tuberculosis of nervous system
A17.9 Tuberculosis of nervous system, unspecified
A18.01 Tuberculosis of spine
A18.02 Tuberculous arthritis of other joints
A18.03 Tuberculosis of other bones
A18.09 Other musculoskeletal tuberculosis
A18.10 Tuberculosis of genitourinary system, unspecified
A18.11 Tuberculosis of kidney and ureter
A18.12 Tuberculosis of bladder
A18.13 Tuberculosis of other urinary organs
A18.14 Tuberculosis of prostate
A18.15 Tuberculosis of other male genital organs
A18.16 Tuberculosis of cervix
A18.17 Tuberculous female pelvic inflammatory disease
A18.18 Tuberculosis of other female genital organs
A18.2 Tuberculous peripheral lymphadenopathy
A18.31 Tuberculous peritonitis
A18.32 Tuberculous enteritis
A18.39 Retroperitoneal tuberculosis
A18.4 Tuberculosis of skin and subcutaneous tissue
A18.50 Tuberculosis of eye, unspecified
A18.51 Tuberculous episcleritis
A18.52 Tuberculous keratitis
A18.53 Tuberculous chorioretinitis
A18.54 Tuberculous iridocyclitis
A18.59 Other tuberculosis of eye
A18.6 Tuberculosis of (inner) (middle) ear
A18.7 Tuberculosis of adrenal glands
A18.81 Tuberculosis of thyroid gland
A18.82 Tuberculosis of other endocrine glands
A18.83 Tuberculosis of digestive tract organs, not elsewhere classified
A18.84 Tuberculosis of heart
A18.85 Tuberculosis of spleen
A18.89 Tuberculosis of other sites
A19.0 Acute miliary tuberculosis of a single specified site
A19.1 Acute miliary tuberculosis of multiple sites
A19.2 Acute miliary tuberculosis, unspecified
A19.8 Other miliary tuberculosis
A19.9 Miliary tuberculosis, unspecified
B38.1 Chronic pulmonary coccidioidomycosis
B38.2 Pulmonary coccidioidomycosis, unspecified
B38.3 Cutaneous coccidioidomycosis
B38.4 Coccidioidomycosis meningitis
B38.7 Disseminated coccidioidomycosis
B38.81 Prostatic coccidioidomycosis
B38.89 Other forms of coccidioidomycosis
B38.9 Coccidioidomycosis, unspecified
B39.1 Chronic pulmonary histoplasmosis capsulati
B39.2 Pulmonary histoplasmosis capsulati, unspecified
B39.3 Disseminated histoplasmosis capsulati
B39.4 Histoplasmosis capsulati, unspecified
B39.5 Histoplasmosis duboisii
B39.9 Histoplasmosis, unspecified
C82.00 Follicular lymphoma grade I, unspecified site
C82.01 Follicular lymphoma grade I, lymph nodes of head, face, and neck
C82.02 Follicular lymphoma grade I, intrathoracic lymph nodes
C82.03 Follicular lymphoma grade I, intra-abdominal lymph nodes
C82.04 Follicular lymphoma grade I, lymph nodes of axilla and upper limb
C82.05 Follicular lymphoma grade I, lymph nodes of inguinal region and lower limb
C82.06 Follicular lymphoma grade I, intrapelvic lymph nodes
C82.07 Follicular lymphoma grade I, spleen
C82.08 Follicular lymphoma grade I, lymph nodes of multiple sites
C82.09 Follicular lymphoma grade I, extranodal and solid organ sites
C82.10 Follicular lymphoma grade II, unspecified site
C82.11 Follicular lymphoma grade II, lymph nodes of head, face, and neck
C82.12 Follicular lymphoma grade II, intrathoracic lymph nodes
C82.13 Follicular lymphoma grade II, intra-abdominal lymph nodes
C82.14 Follicular lymphoma grade II, lymph nodes of axilla and upper limb
C82.15 Follicular lymphoma grade II, lymph nodes of inguinal region and lower limb
C82.16 Follicular lymphoma grade II, intrapelvic lymph nodes
C82.17 Follicular lymphoma grade II, spleen
C82.18 Follicular lymphoma grade II, lymph nodes of multiple sites
C82.19 Follicular lymphoma grade II, extranodal and solid organ sites
C82.20 Follicular lymphoma grade III, unspecified, unspecified site
C82.21 Follicular lymphoma grade III, unspecified, lymph nodes of head, face, and neck
C82.22 Follicular lymphoma grade III, unspecified, intrathoracic lymph nodes
C82.23 Follicular lymphoma grade III, unspecified, intra-abdominal lymph nodes
C82.24 Follicular lymphoma grade III, unspecified, lymph nodes of axilla and upper limb
C82.25 Follicular lymphoma grade III, unspecified, lymph nodes of inguinal region and lower limb
C82.26 Follicular lymphoma grade III, unspecified, intrapelvic lymph nodes
C82.27 Follicular lymphoma grade III, unspecified, spleen
C82.28 Follicular lymphoma grade III, unspecified, lymph nodes of multiple sites
C82.29 Follicular lymphoma grade III, unspecified, extranodal and solid organ sites
C82.30 Follicular lymphoma grade IIIa, unspecified site
C82.31 Follicular lymphoma grade IIIa, lymph nodes of head, face, and neck
C82.32 Follicular lymphoma grade IIIa, intrathoracic lymph nodes
C82.33 Follicular lymphoma grade IIIa, intra-abdominal lymph nodes
C82.34 Follicular lymphoma grade IIIa, lymph nodes of axilla and upper limb
C82.35 Follicular lymphoma grade IIIa, lymph nodes of inguinal region and lower limb
C82.36 Follicular lymphoma grade IIIa, intrapelvic lymph nodes
C82.37 Follicular lymphoma grade IIIa, spleen
C82.38 Follicular lymphoma grade IIIa, lymph nodes of multiple sites
C82.39 Follicular lymphoma grade IIIa, extranodal and solid organ sites
C82.40 Follicular lymphoma grade IIIb, unspecified site
C82.41 Follicular lymphoma grade IIIb, lymph nodes of head, face, and neck
C82.42 Follicular lymphoma grade IIIb, intrathoracic lymph nodes
C82.43 Follicular lymphoma grade IIIb, intra-abdominal lymph nodes
C82.44 Follicular lymphoma grade IIIb, lymph nodes of axilla and upper limb
C82.45 Follicular lymphoma grade IIIb, lymph nodes of inguinal region and lower limb
C82.46 Follicular lymphoma grade IIIb, intrapelvic lymph nodes
C82.47 Follicular lymphoma grade IIIb, spleen
C82.48 Follicular lymphoma grade IIIb, lymph nodes of multiple sites
C82.49 Follicular lymphoma grade IIIb, extranodal and solid organ sites
C82.50 Diffuse follicle center lymphoma, unspecified site
C82.51 Diffuse follicle center lymphoma, lymph nodes of head, face, and neck
C82.52 Diffuse follicle center lymphoma, intrathoracic lymph nodes
C82.53 Diffuse follicle center lymphoma, intra-abdominal lymph nodes
C82.54 Diffuse follicle center lymphoma, lymph nodes of axilla and upper limb
C82.55 Diffuse follicle center lymphoma, lymph nodes of inguinal region and lower limb
C82.56 Diffuse follicle center lymphoma, intrapelvic lymph nodes
C82.57 Diffuse follicle center lymphoma, spleen
C82.58 Diffuse follicle center lymphoma, lymph nodes of multiple sites
C82.59 Diffuse follicle center lymphoma, extranodal and solid organ sites
C82.60 Cutaneous follicle center lymphoma, unspecified site
C82.61 Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck
C82.62 Cutaneous follicle center lymphoma, intrathoracic lymph nodes
C82.63 Cutaneous follicle center lymphoma, intra-abdominal lymph nodes
C82.64 Cutaneous follicle center lymphoma, lymph nodes of axilla and upper limb
C82.65 Cutaneous follicle center lymphoma, lymph nodes of inguinal region and lower limb
C82.66 Cutaneous follicle center lymphoma, intrapelvic lymph nodes
C82.67 Cutaneous follicle center lymphoma, spleen
C82.68 Cutaneous follicle center lymphoma, lymph nodes of multiple sites
C82.69 Cutaneous follicle center lymphoma, extranodal and solid organ sites
C82.80 Other types of follicular lymphoma, unspecified site
C82.81 Other types of follicular lymphoma, lymph nodes of head, face, and neck
C82.82 Other types of follicular lymphoma, intrathoracic lymph nodes
C82.83 Other types of follicular lymphoma, intra-abdominal lymph nodes
C82.84 Other types of follicular lymphoma, lymph nodes of axilla and upper limb
C82.85 Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb
C82.86 Other types of follicular lymphoma, intrapelvic lymph nodes
C82.87 Other types of follicular lymphoma, spleen
C82.88 Other types of follicular lymphoma, lymph nodes of multiple sites
C82.89 Other types of follicular lymphoma, extranodal and solid organ sites
C82.90 Follicular lymphoma, unspecified, unspecified site
C82.91 Follicular lymphoma, unspecified, lymph nodes of head, face, and neck
C82.92 Follicular lymphoma, unspecified, intrathoracic lymph nodes
C82.93 Follicular lymphoma, unspecified, intra-abdominal lymph nodes
C82.94 Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb
C82.95 Follicular lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C82.96 Follicular lymphoma, unspecified, intrapelvic lymph nodes
C82.97 Follicular lymphoma, unspecified, spleen
C82.98 Follicular lymphoma, unspecified, lymph nodes of multiple sites
C82.99 Follicular lymphoma, unspecified, extranodal and solid organ sites
D86.0 Sarcoidosis of lung
D86.1 Sarcoidosis of lymph nodes
D86.2 Sarcoidosis of lung with sarcoidosis of lymph nodes
D86.3 Sarcoidosis of skin
D86.81 Sarcoid meningitis
D86.82 Multiple cranial nerve palsies in sarcoidosis
D86.83 Sarcoid iridocyclitis
D86.84 Sarcoid pyelonephritis
D86.85 Sarcoid myocarditis
D86.86 Sarcoid arthropathy
D86.87 Sarcoid myositis
D86.89 Sarcoidosis of other sites
D86.9 Sarcoidosis, unspecified
E20.0 Idiopathic hypoparathyroidism
E20.8 Other hypoparathyroidism
E20.9 Hypoparathyroidism, unspecified
E21.0 Primary hyperparathyroidism
E21.1 Secondary hyperparathyroidism, not elsewhere classified
E21.2 Other hyperparathyroidism
E21.3 Hyperparathyroidism, unspecified
E55.0 Rickets, active
E55.9 Vitamin D deficiency, unspecified
E67.3 Hypervitaminosis D
E67.8 Other specified hyperalimentation
E68 Sequelae of hyperalimentation
E83.30 Disorder of phosphorus metabolism, unspecified
E83.31 Familial hypophosphatemia
E83.32 Hereditary vitamin D-dependent rickets (type 1) (type 2)
E83.39 Other disorders of phosphorus metabolism
E83.51 Hypocalcemia
E83.52 Hypercalcemia
E83.59 Other disorders of calcium metabolism
E84.0 Cystic fibrosis with pulmonary manifestations
E84.19 Cystic fibrosis with other intestinal manifestations
E84.8 Cystic fibrosis with other manifestations
E89.2 Postprocedural hypoparathyroidism
G73.7 Myopathy in diseases classified elsewhere
J63.2 Berylliosis
K50.00 Crohn's disease of small intestine without complications
K50.011 Crohn's disease of small intestine with rectal bleeding
K50.012 Crohn's disease of small intestine with intestinal obstruction
K50.013 Crohn's disease of small intestine with fistula
K50.014 Crohn's disease of small intestine with abscess
K50.018 Crohn's disease of small intestine with other complication
K50.019 Crohn's disease of small intestine with unspecified complications
K50.10 Crohn's disease of large intestine without complications
K50.111 Crohn's disease of large intestine with rectal bleeding
K50.112 Crohn's disease of large intestine with intestinal obstruction
K50.113 Crohn's disease of large intestine with fistula
K50.114 Crohn's disease of large intestine with abscess
K50.118 Crohn's disease of large intestine with other complication
K50.119 Crohn's disease of large intestine with unspecified complications
K50.80 Crohn's disease of both small and large intestine without complications
K50.811 Crohn's disease of both small and large intestine with rectal bleeding
K50.812 Crohn's disease of both small and large intestine with intestinal obstruction
K50.813 Crohn's disease of both small and large intestine with fistula
K50.814 Crohn's disease of both small and large intestine with abscess
K50.818 Crohn's disease of both small and large intestine with other complication
K50.819 Crohn's disease of both small and large intestine with unspecified complications
K50.90 Crohn's disease, unspecified, without complications
K50.911 Crohn's disease, unspecified, with rectal bleeding
K50.912 Crohn's disease, unspecified, with intestinal obstruction
K50.913 Crohn's disease, unspecified, with fistula
K50.914 Crohn's disease, unspecified, with abscess
K50.918 Crohn's disease, unspecified, with other complication
K50.919 Crohn's disease, unspecified, with unspecified complications
K51.00 Ulcerative (chronic) pancolitis without complications
K51.011 Ulcerative (chronic) pancolitis with rectal bleeding
K51.012 Ulcerative (chronic) pancolitis with intestinal obstruction
K51.013 Ulcerative (chronic) pancolitis with fistula
K51.014 Ulcerative (chronic) pancolitis with abscess
K51.018 Ulcerative (chronic) pancolitis with other complication
K51.019 Ulcerative (chronic) pancolitis with unspecified complications
K51.20 Ulcerative (chronic) proctitis without complications
K51.211 Ulcerative (chronic) proctitis with rectal bleeding
K51.212 Ulcerative (chronic) proctitis with intestinal obstruction
K51.213 Ulcerative (chronic) proctitis with fistula
K51.214 Ulcerative (chronic) proctitis with abscess
K51.218 Ulcerative (chronic) proctitis with other complication
K51.219 Ulcerative (chronic) proctitis with unspecified complications
K51.30 Ulcerative (chronic) rectosigmoiditis without complications
K51.311 Ulcerative (chronic) rectosigmoiditis with rectal bleeding
K51.312 Ulcerative (chronic) rectosigmoiditis with intestinal obstruction
K51.313 Ulcerative (chronic) rectosigmoiditis with fistula
K51.314 Ulcerative (chronic) rectosigmoiditis with abscess
K51.318 Ulcerative (chronic) rectosigmoiditis with other complication
K51.319 Ulcerative (chronic) rectosigmoiditis with unspecified complications
K51.40 Inflammatory polyps of colon without complications
K51.411 Inflammatory polyps of colon with rectal bleeding
K51.412 Inflammatory polyps of colon with intestinal obstruction
K51.413 Inflammatory polyps of colon with fistula
K51.414 Inflammatory polyps of colon with abscess
K51.418 Inflammatory polyps of colon with other complication
K51.419 Inflammatory polyps of colon with unspecified complications
K51.50 Left sided colitis without complications
K51.511 Left sided colitis with rectal bleeding
K51.512 Left sided colitis with intestinal obstruction
K51.513 Left sided colitis with fistula
K51.514 Left sided colitis with abscess
K51.518 Left sided colitis with other complication
K51.519 Left sided colitis with unspecified complications
K51.80 Other ulcerative colitis without complications
K51.811 Other ulcerative colitis with rectal bleeding
K51.812 Other ulcerative colitis with intestinal obstruction
K51.813 Other ulcerative colitis with fistula
K51.814 Other ulcerative colitis with abscess
K51.818 Other ulcerative colitis with other complication
K51.819 Other ulcerative colitis with unspecified complications
K51.90 Ulcerative colitis, unspecified, without complications
K51.911 Ulcerative colitis, unspecified with rectal bleeding
K51.912 Ulcerative colitis, unspecified with intestinal obstruction
K51.913 Ulcerative colitis, unspecified with fistula
K51.914 Ulcerative colitis, unspecified with abscess
K51.918 Ulcerative colitis, unspecified with other complication
K51.919 Ulcerative colitis, unspecified with unspecified complications
K52.0 Gastroenteritis and colitis due to radiation
K70.2 Alcoholic fibrosis and sclerosis of liver
K70.30 Alcoholic cirrhosis of liver without ascites
K70.31 Alcoholic cirrhosis of liver with ascites
K74.00 Hepatic fibrosis, unspecified
K74.01 Hepatic fibrosis, early fibrosis
K74.02 Hepatic fibrosis, advanced fibrosis
K74.3 Primary biliary cirrhosis
K74.4 Secondary biliary cirrhosis
K74.5 Biliary cirrhosis, unspecified
K74.60 Unspecified cirrhosis of liver
K74.69 Other cirrhosis of liver
K83.5 Biliary cyst
K83.8 Other specified diseases of biliary tract
K87 Disorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere
K90.0 Celiac disease
K90.1 Tropical sprue
K90.2 Blind loop syndrome, not elsewhere classified
K90.3 Pancreatic steatorrhea
K90.49 Malabsorption due to intolerance, not elsewhere classified
K90.81 Whipple's disease
K90.89 Other intestinal malabsorption
K90.9 Intestinal malabsorption, unspecified
K91.2 Postsurgical malabsorption, not elsewhere classified
L40.0 Psoriasis vulgaris
L40.1 Generalized pustular psoriasis
L40.2 Acrodermatitis continua
L40.3 Pustulosis palmaris et plantaris
L40.4 Guttate psoriasis
L40.50 Arthropathic psoriasis, unspecified
L40.51 Distal interphalangeal psoriatic arthropathy
L40.52 Psoriatic arthritis mutilans
L40.53 Psoriatic spondylitis
L40.54 Psoriatic juvenile arthropathy
L40.59 Other psoriatic arthropathy
L40.8 Other psoriasis
L40.9 Psoriasis, unspecified
M32.0 Drug-induced systemic lupus erythematosus
M32.10 Systemic lupus erythematosus, organ or system involvement unspecified
M32.11 Endocarditis in systemic lupus erythematosus
M32.12 Pericarditis in systemic lupus erythematosus
M32.13 Lung involvement in systemic lupus erythematosus
M32.14 Glomerular disease in systemic lupus erythematosus
M32.15 Tubulo-interstitial nephropathy in systemic lupus erythematosus
M32.19 Other organ or system involvement in systemic lupus erythematosus
M32.8 Other forms of systemic lupus erythematosus
M32.9 Systemic lupus erythematosus, unspecified
M33.00 Juvenile dermatomyositis, organ involvement unspecified
M33.01 Juvenile dermatomyositis with respiratory involvement
M33.02 Juvenile dermatomyositis with myopathy
M33.09 Juvenile dermatomyositis with other organ involvement
M33.10 Other dermatomyositis, organ involvement unspecified
M33.11 Other dermatomyositis with respiratory involvement
M33.12 Other dermatomyositis with myopathy
M33.19 Other dermatomyositis with other organ involvement
M33.20 Polymyositis, organ involvement unspecified
M33.21 Polymyositis with respiratory involvement
M33.22 Polymyositis with myopathy
M33.29 Polymyositis with other organ involvement
M33.90 Dermatopolymyositis, unspecified, organ involvement unspecified
M33.91 Dermatopolymyositis, unspecified with respiratory involvement
M33.92 Dermatopolymyositis, unspecified with myopathy
M33.99 Dermatopolymyositis, unspecified with other organ involvement
M36.0 Dermato(poly)myositis in neoplastic disease
M60.80 Other myositis, unspecified site
M60.811 Other myositis, right shoulder
M60.812 Other myositis, left shoulder
M60.819 Other myositis, unspecified shoulder
M60.821 Other myositis, right upper arm
M60.822 Other myositis, left upper arm
M60.829 Other myositis, unspecified upper arm
M60.831 Other myositis, right forearm
M60.832 Other myositis, left forearm
M60.839 Other myositis, unspecified forearm
M60.841 Other myositis, right hand
M60.842 Other myositis, left hand
M60.849 Other myositis, unspecified hand
M60.851 Other myositis, right thigh
M60.852 Other myositis, left thigh
M60.859 Other myositis, unspecified thigh
M60.861 Other myositis, right lower leg
M60.862 Other myositis, left lower leg
M60.869 Other myositis, unspecified lower leg
M60.871 Other myositis, right ankle and foot
M60.872 Other myositis, left ankle and foot
M60.879 Other myositis, unspecified ankle and foot
M60.88 Other myositis, other site
M60.89 Other myositis, multiple sites
M60.9 Myositis, unspecified
M79.11 Myalgia of mastication muscle
M79.12 Myalgia of auxiliary muscles, head and neck
M79.18 Myalgia, other site
M79.7 Fibromyalgia
M80.00XA - M80.00XS - Age-related osteoporosis with current pathological fracture, unspecified site, sequela
M80.011A - M80.011S - Age-related osteoporosis with current pathological fracture, right shoulder, sequela
M80.012A - M80.012S - Age-related osteoporosis with current pathological fracture, left shoulder, sequela
M80.019A - M80.019S - Age-related osteoporosis with current pathological fracture, unspecified shoulder, sequela
M80.021A - M80.021S - Age-related osteoporosis with current pathological fracture, right humerus, sequela
M80.022A - M80.022S - Age-related osteoporosis with current pathological fracture, left humerus, sequela
M80.029A - M80.029S - Age-related osteoporosis with current pathological fracture, unspecified humerus, sequela
M80.031A - M80.031S - Age-related osteoporosis with current pathological fracture, right forearm, sequela
M80.032A - M80.032S - Age-related osteoporosis with current pathological fracture, left forearm, sequela
M80.039A - M80.039S - Age-related osteoporosis with current pathological fracture, unspecified forearm, sequela
M80.041A - M80.041S - Age-related osteoporosis with current pathological fracture, right hand, sequela
M80.042A - M80.042S - Age-related osteoporosis with current pathological fracture, left hand, sequela
M80.049A - M80.049S - Age-related osteoporosis with current pathological fracture, unspecified hand, sequela
M80.051A - M80.051S - Age-related osteoporosis with current pathological fracture, right femur, sequela
M80.052A - M80.052S - Age-related osteoporosis with current pathological fracture, left femur, sequela
M80.059A - M80.059S - Age-related osteoporosis with current pathological fracture, unspecified femur, sequela
M80.061A - M80.061S - Age-related osteoporosis with current pathological fracture, right lower leg, sequela
M80.062A - M80.062S - Age-related osteoporosis with current pathological fracture, left lower leg, sequela
M80.069A - M80.069S - Age-related osteoporosis with current pathological fracture, unspecified lower leg, sequela
M80.071A - M80.071S - Age-related osteoporosis with current pathological fracture, right ankle and foot, sequela
M80.072A - M80.072S - Age-related osteoporosis with current pathological fracture, left ankle and foot, sequela
M80.079A - M80.079S - Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, sequela
M80.08XA - M80.08XS - Age-related osteoporosis with current pathological fracture, vertebra(e), sequela
M80.80XA - M80.80XS - Other osteoporosis with current pathological fracture, unspecified site, sequela
M80.811A - M80.811S - Other osteoporosis with current pathological fracture, right shoulder, sequela
M80.812A - M80.812S - Other osteoporosis with current pathological fracture, left shoulder, sequela
M80.819A - M80.819S - Other osteoporosis with current pathological fracture, unspecified shoulder, sequela
M80.821A - M80.821S - Other osteoporosis with current pathological fracture, right humerus, sequela
M80.822A - M80.822S - Other osteoporosis with current pathological fracture, left humerus, sequela
M80.829A - M80.829S - Other osteoporosis with current pathological fracture, unspecified humerus, sequela
M80.831A - M80.831S - Other osteoporosis with current pathological fracture, right forearm, sequela
M80.832A - M80.832S - Other osteoporosis with current pathological fracture, left forearm, sequela
M80.839A - M80.839S - Other osteoporosis with current pathological fracture, unspecified forearm, sequela
M80.841A - M80.841S - Other osteoporosis with current pathological fracture, right hand, sequela
M80.842A - M80.842S - Other osteoporosis with current pathological fracture, left hand, sequela
M80.849A - M80.849S - Other osteoporosis with current pathological fracture, unspecified hand, sequela
M80.851A - M80.851S - Other osteoporosis with current pathological fracture, right femur, sequela
M80.852A - M80.852S - Other osteoporosis with current pathological fracture, left femur, sequela
M80.859A - M80.859S - Other osteoporosis with current pathological fracture, unspecified femur, sequela
M80.861A - M80.861S - Other osteoporosis with current pathological fracture, right lower leg, sequela
M80.862A - M80.862S - Other osteoporosis with current pathological fracture, left lower leg, sequela
M80.869A - M80.869S - Other osteoporosis with current pathological fracture, unspecified lower leg, sequela
M80.871A - M80.871S - Other osteoporosis with current pathological fracture, right ankle and foot, sequela
M80.872A - M80.872S - Other osteoporosis with current pathological fracture, left ankle and foot, sequela
M80.879A - M80.879S - Other osteoporosis with current pathological fracture, unspecified ankle and foot, sequela
M80.88XA - M80.88XS - Other osteoporosis with current pathological fracture, vertebra(e), sequela
M81.0 Age-related osteoporosis without current pathological fracture
M81.6 Localized osteoporosis [Lequesne]
M81.8 Other osteoporosis without current pathological fracture
M83.0 Puerperal osteomalacia
M83.1 Senile osteomalacia
M83.2 Adult osteomalacia due to malabsorption
M83.3 Adult osteomalacia due to malnutrition
M83.4 Aluminum bone disease
M83.5 Other drug-induced osteomalacia in adults
M83.8 Other adult osteomalacia
M83.9 Adult osteomalacia, unspecified
M85.80 Other specified disorders of bone density and structure, unspecified site
M85.9 Disorder of bone density and structure, unspecified
M89.9 Disorder of bone, unspecified
M94.9 Disorder of cartilage, unspecified
N18.30 Chronic kidney disease, stage 3 unspecified
N18.31 Chronic kidney disease, stage 3a
N18.32 Chronic kidney disease, stage 3b
N18.4 Chronic kidney disease, stage 4 (severe)
N18.5 Chronic kidney disease, stage 5
N18.6 End stage renal disease
N25.81 Secondary hyperparathyroidism of renal origin
Q78.0 Osteogenesis imperfecta
Q78.2 Osteopetrosis
Z68.30 Body mass index [BMI] 30.0-30.9, adult
Z68.31 Body mass index [BMI] 31.0-31.9, adult
Z68.32 Body mass index [BMI] 32.0-32.9, adult
Z68.33 Body mass index [BMI] 33.0-33.9, adult
Z68.34 Body mass index [BMI] 34.0-34.9, adult
Z68.35 Body mass index [BMI] 35.0-35.9, adult
Z68.36 Body mass index [BMI] 36.0-36.9, adult
Z68.37 Body mass index [BMI] 37.0-37.9, adult
Z68.38 Body mass index [BMI] 38.0-38.9, adult
Z68.39 Body mass index [BMI] 39.0-39.9, adult
Z68.41 Body mass index [BMI] 40.0-44.9, adult
Z68.42 Body mass index [BMI] 45.0-49.9, adult
Z68.43 Body mass index [BMI] 50.0-59.9, adult
Z68.44 Body mass index [BMI] 60.0-69.9, adult
Z68.45 Body mass index [BMI] 70 or greater, adult
Z79.3 Long term (current) use of hormonal contraceptives
Z79.51 Long term (current) use of inhaled steroids
Z79.52 Long term (current) use of systemic steroids
Z79.891 Long term (current) use of opiate analgesic
Z79.899 Other long term (current) drug therapy
Z98.0 Intestinal bypass and anastomosis status
Z98.84 Bariatric surgery status

The following ICD-10-CM codes support medical necessity and provide coverage for (CPT/HCPCS) code: 82379

D63.1 Anemia in chronic kidney disease
E71.40 Disorder of carnitine metabolism, unspecified
E71.41 Primary carnitine deficiency
E71.42 Carnitine deficiency due to inborn errors of metabolism
E71.43 Iatrogenic carnitine deficiency
E71.440 Ruvalcaba-Myhre-Smith syndrome
E71.448 Other secondary carnitine deficiency
I95.3 Hypotension of hemodialysis

The following ICD-10-CM codes support medical necessity and provide coverage for (CPT/HCPCS) codes: 82607, 82746 and 83090

D51.0 Vitamin B12 deficiency anemia due to intrinsic factor deficiency
D51.1 Vitamin B12 deficiency anemia due to selective vitamin B12 malabsorption with proteinuria
D51.2 Transcobalamin II deficiency
D51.3 Other dietary vitamin B12 deficiency anemia
D51.8 Other vitamin B12 deficiency anemias
D51.9 Vitamin B12 deficiency anemia, unspecified
D52.0 Dietary folate deficiency anemia
D52.1 Drug-induced folate deficiency anemia
D52.8 Other folate deficiency anemias
D52.9 Folate deficiency anemia, unspecified
D53.1 Other megaloblastic anemias, not elsewhere classified
D53.9 Nutritional anemia, unspecified
D69.6 Thrombocytopenia, unspecified
D81.818 Other biotin-dependent carboxylase deficiency
D81.819 Biotin-dependent carboxylase deficiency, unspecified
E41 Nutritional marasmus
E43 Unspecified severe protein-calorie malnutrition
E45 Retarded development following protein-calorie malnutrition
E46 Unspecified protein-calorie malnutrition
E53.8 Deficiency of other specified B group vitamins
E64.0 Sequelae of protein-calorie malnutrition
E72.10 Disorders of sulfur-bearing amino-acid metabolism, unspecified
E72.11 Homocystinuria
E72.12 Methylenetetrahydrofolate reductase deficiency
E72.19 Other disorders of sulfur-bearing amino-acid metabolism
F03.90 Unspecified dementia without behavioral disturbance
F03.91 Unspecified dementia with behavioral disturbance
F10.20 Alcohol dependence, uncomplicated
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
G30.0 Alzheimer's disease with early onset
G30.1 Alzheimer's disease with late onset
G30.8 Other Alzheimer's disease
G30.9 Alzheimer's disease, unspecified
G60.3 Idiopathic progressive neuropathy
G60.9 Hereditary and idiopathic neuropathy, unspecified
K14.0 Glossitis
K14.6 Glossodynia
K31.83 Achlorhydria
K50.00 Crohn's disease of small intestine without complications
K50.011 Crohn's disease of small intestine with rectal bleeding
K50.012 Crohn's disease of small intestine with intestinal obstruction
K50.013 Crohn's disease of small intestine with fistula
K50.014 Crohn's disease of small intestine with abscess
K50.018 Crohn's disease of small intestine with other complication
K50.019 Crohn's disease of small intestine with unspecified complications
K50.10 Crohn's disease of large intestine without complications
K50.111 Crohn's disease of large intestine with rectal bleeding
K50.112 Crohn's disease of large intestine with intestinal obstruction
K50.113 Crohn's disease of large intestine with fistula
K50.114 Crohn's disease of large intestine with abscess
K50.118 Crohn's disease of large intestine with other complication
K50.119 Crohn's disease of large intestine with unspecified complications
K50.80 Crohn's disease of both small and large intestine without complications
K50.811 Crohn's disease of both small and large intestine with rectal bleeding
K50.812 Crohn's disease of both small and large intestine with intestinal obstruction
K50.813 Crohn's disease of both small and large intestine with fistula
K50.814 Crohn's disease of both small and large intestine with abscess
K50.818 Crohn's disease of both small and large intestine with other complication
K50.819 Crohn's disease of both small and large intestine with unspecified complications
K50.90 Crohn's disease, unspecified, without complications
K50.911 Crohn's disease, unspecified, with rectal bleeding
K50.912 Crohn's disease, unspecified, with intestinal obstruction
K50.913 Crohn's disease, unspecified, with fistula
K50.914 Crohn's disease, unspecified, with abscess
K50.918 Crohn's disease, unspecified, with other complication
K50.919 Crohn's disease, unspecified, with unspecified complications
K90.0 Celiac disease
K90.1 Tropical sprue
K90.2 Blind loop syndrome, not elsewhere classified
K90.3 Pancreatic steatorrhea
K90.49 Malabsorption due to intolerance, not elsewhere classified
K90.81 Whipple's disease
K90.89 Other intestinal malabsorption
K90.9 Intestinal malabsorption, unspecified
K91.2 Postsurgical malabsorption, not elsewhere classified
R20.0 Anesthesia of skin
R20.1 Hypoesthesia of skin
R20.2 Paresthesia of skin
R20.3 Hyperesthesia
R20.8 Other disturbances of skin sensation
R20.9 Unspecified disturbances of skin sensation
R26.0 Ataxic gait
R26.1 Paralytic gait
R26.81 Unsteadiness on feet
R26.89 Other abnormalities of gait and mobility
R26.9 Unspecified abnormalities of gait and mobility
R27.0 Ataxia, unspecified
R27.8 Other lack of coordination
R27.9 Unspecified lack of coordination
R41.1 Anterograde amnesia
R41.2 Retrograde amnesia
R41.3 Other amnesia
R41.82 Altered mental status, unspecified
R41.9 Unspecified symptoms and signs involving cognitive functions and awareness
R45.84 Anhedonia
Z51.11 Encounter for antineoplastic chemotherapy
Z79.3 Long term (current) use of hormonal contraceptives
Z79.891 Long term (current) use of opiate analgesic
Z79.899 Other long term (current) drug therapy
Z86.39 Personal history of other endocrine, nutritional and metabolic disease
Z98.0 Intestinal bypass and anastomosis status
Z99.2 Dependence on renal dialysis

The following ICD-10-CM codes support medical necessity and provide coverage for (CPT/HCPCS) code: 84207

D64.0 Hereditary sideroblastic anemia
D64.1 Secondary sideroblastic anemia due to disease
D64.2 Secondary sideroblastic anemia due to drugs and toxins
D64.3 Other sideroblastic anemias
E53.1 Pyridoxine deficiency
E67.2 Megavitamin-B6 syndrome
E83.39 Other disorders of phosphorus metabolism
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
G60.9 Hereditary and idiopathic neuropathy, unspecified
K14.0 Glossitis
R74.8 Abnormal levels of other serum enzymes

The following ICD-10-CM codes support medical necessity and provide coverage for (CPT/HCPCS) code: 85385

D47.3 Essential (hemorrhagic) thrombocythemia
D65 Disseminated intravascular coagulation [defibrination syndrome]
D68.2 Hereditary deficiency of other clotting factors
D68.32 Hemorrhagic disorder due to extrinsic circulating anticoagulants
D68.4 Acquired coagulation factor deficiency
D69.3 Immune thrombocytopenic purpura
D69.41 Evans syndrome
D69.42 Congenital and hereditary thrombocytopenia purpura
D69.49 Other primary thrombocytopenia
D69.51 Posttransfusion purpura
D69.59 Other secondary thrombocytopenia
D69.6 Thrombocytopenia, unspecified
R79.1 Abnormal coagulation profile

The following ICD-10-CM codes support medical necessity and provide coverage for (CPT/HCPCS) code: 86352

D81.4 Nezelof's syndrome
D82.0 Wiskott-Aldrich syndrome
D82.1 Di George's syndrome
D83.1 Common variable immunodeficiency with predominant immunoregulatory T-cell disorders
T86.00 Unspecified complication of bone marrow transplant
T86.01 Bone marrow transplant rejection
T86.02 Bone marrow transplant failure
T86.03 Bone marrow transplant infection
T86.09 Other complications of bone marrow transplant
T86.10 Unspecified complication of kidney transplant
T86.11 Kidney transplant rejection
T86.12 Kidney transplant failure
T86.13 Kidney transplant infection
T86.19 Other complication of kidney transplant
T86.20 Unspecified complication of heart transplant
T86.21 Heart transplant rejection
T86.22 Heart transplant failure
T86.23 Heart transplant infection
T86.290 Cardiac allograft vasculopathy
T86.298 Other complications of heart transplant
T86.30 Unspecified complication of heart-lung transplant
T86.31 Heart-lung transplant rejection
T86.32 Heart-lung transplant failure
T86.33 Heart-lung transplant infection
T86.39 Other complications of heart-lung transplant
T86.40 Unspecified complication of liver transplant
T86.41 Liver transplant rejection
T86.42 Liver transplant failure
T86.43 Liver transplant infection
T86.49 Other complications of liver transplant
T86.5 Complications of stem cell transplant
T86.810 Lung transplant rejection
T86.811 Lung transplant failure
T86.812 Lung transplant infection
T86.818 Other complications of lung transplant
T86.819 Unspecified complication of lung transplant
T86.850 Intestine transplant rejection
T86.851 Intestine transplant failure
T86.852 Intestine transplant infection
T86.858 Other complications of intestine transplant
T86.859 Unspecified complication of intestine transplant
T86.890 Other transplanted tissue rejection
T86.891 Other transplanted tissue failure
T86.892 Other transplanted tissue infection
T86.898 Other complications of other transplanted tissue
T86.899 Unspecified complication of other transplanted tissue
Z48.21 Encounter for aftercare following heart transplant
Z48.22 Encounter for aftercare following kidney transplant
Z48.23 Encounter for aftercare following liver transplant
Z48.24 Encounter for aftercare following lung transplant
Z48.280 Encounter for aftercare following heart-lung transplant
Z48.290 Encounter for aftercare following bone marrow transplant
Z94.0 Kidney transplant status
Z94.1 Heart transplant status
Z94.2 Lung transplant status
Z94.3 Heart and lungs transplant status
Z94.4 Liver transplant status
Z94.81 Bone marrow transplant status
Z94.82 Intestine transplant status
Z94.83 Pancreas transplant status

The following ICD-10-CM codes support medical necessity and provide coverage for (CPT/HCPCS) code: 83698

E11.65 Type 2 diabetes mellitus with hyperglycemia
E11.9 Type 2 diabetes mellitus without complications
E13.9 Other specified diabetes mellitus without complications
E78.00 Pure hypercholesterolemia, unspecified
E78.01 Familial hypercholesterolemia
E78.1 Pure hyperglyceridemia
E78.2 Mixed hyperlipidemia
E78.3 Hyperchylomicronemia
E78.49 Other hyperlipidemia
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
ICD-10 Codes That Are Not Covered

XX000


Revision History Information
Revision History DateRevision History NumberRevision History Explanation
10/01/2021
R6

Article revised and published on 10/14/2021 effective for dates of service on and after 10/01/2021 to reflect the annual ICD-10-CM code updates. The following ICD-10-CM codes have undergone a descriptor change: Z68.30 and Z68.41 in Group 1.

10/01/2020
R5

Article revised and published on 10/01/2020 effective for dates of service on and after 10/01/2020 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM code(s) have been added to the Group 1 Codes: K74.00, K74.01, K74.02, N18.30, N18.31, N18.32. The following ICD-10-CM code(s) have been deleted from the Group 1 Codes: K74.0 and N18.3. The following Group 1 ICD-10-CM code(s) have undergone a descriptor change: Z68.30, Z68.31, Z68.32, Z68.33, Z68.34, Z68.35, Z68.36, Z68.37, Z68.38, Z68.39, Z68.41, Z68.42, Z68.43, Z68.44, Z68.45.

07/01/2020
R4

Article revised and published on 06/25/2020 effective for dates of service on and after 07/01/2020, as a non-discretionary update to remove the group 9 paragraph note and codes. Minor formatting changes have been made.

10/01/2019
R3

Article revised and published on 10/17/2019 effective for dates of service on and after 10/01/2019 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM code has undergone a descriptor change: Z68.43. Please note, system changes have been made to our articles in response to CMS Change Request 10901. The Coding Section has been reordered and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

03/28/2019
R2

Article revised and published on 04/18/2019 to correct the revision history explanation from 03/28/2019. The revision history for 03/28/2019 should read Article revised and published on 03/28/2019 to add reporting guidelines and to add the CPT and ICD-10 codes from the related L34914, Assays for Vitamins and Metabolic Function.

03/28/2019
R1

Article revised and published on 03/28/2019 to add the CPT and ICD-10 codes from the related LCD, L35424 Chiropractic Services in response to CMS Change Request 10901. Information in the billing for chiropractic services section revised to ensure consistency with IOM language. Deleted information regarding services being denied.