Local Coverage Article Billing and Coding

Billing and Coding: Measurement of Salivary Hormones

A57612

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Contractor Information

Article Information

General Information

Article ID
A57612
Article Title
Billing and Coding: Measurement of Salivary Hormones
Article Type
Billing and Coding
Original Effective Date
11/01/2019
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
N/A
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Code of Federal Regulations:

42 CFR Sections 410.32(a) & 410.32(a)(3) require that clinical laboratory services be ordered and used promptly by the physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who is treating the beneficiary.

42CFR411.15 excludes from coverage examinations performed for a purpose other than treatment or diagnosis of a specific illness, symptoms, complaint, or injury with specific legislative enactments as the only exceptions.

CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, §§20.4.4 and 20.4.5.

Article Guidance

Article Text

The following coding and billing guidance is to be used with its associated Local coverage determination.

If requested, chart documentation would show signs, symptoms, or clinical reasons why Cushing’s syndrome was being tested for.

No comments were received for this draft LCD for comment period ending 12/15/2016.

Coding Information

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

Because current CPT® codes do not specify or identify “salivary” hormone testing from serum or urine hormone testing, claims for salivary levels of hormone should be coded with NOS code 84999 and the words “salivary cortisol”. For other than cortisol use “salivary (name of other hormone)” which will generate a denial.

Group 1 Codes
CodeDescription
84999 UNLISTED CHEMISTRY PROCEDURE

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(8 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
E24.0 Pituitary-dependent Cushing's disease
E24.2 Drug-induced Cushing's syndrome
E24.3 Ectopic ACTH syndrome
E24.4 Alcohol-induced pseudo-Cushing's syndrome
E24.8 Other Cushing's syndrome
E24.9 Cushing's syndrome, unspecified
E27.0 Other adrenocortical overactivity
E27.8 Other specified disorders of adrenal gland
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

Additional ICD-10 Information

N/A

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 article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

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 article, 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 article should be assumed to apply equally to all Revenue Codes.

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Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

Revision History Information

N/A

Associated Documents

Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
10/22/2019 11/01/2019 - N/A Currently in Effect You are here

Keywords

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