Cpt code 82728 medical necessity. Please note the terms of a customer’s particular .

Cpt code 82728 medical necessity Coverage Indications, Limitations, and/or Medical Necessity Immunoassay determinations of the serum levels of certain proteins or carbohydrates serve as tumor markers. COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service. When an End Stage Renal Disease (ESRD) patient is tested for ferritin, testing more frequently than every three months requires documentation of medical necessity (e. ICD-10-CM codes are only included in Articles, or possibly in retired versions of LCDs. An excess of vitamin D may lead to hypercalcemia. Iron deficiency is the most common cause of anemia. UnitedHealthcare Community Plan will not reimburse when the treatment rendered is without inclusion of one of the ICD-10-CM diagnostic codes being included on the claim accurately reflecting the member's condition. If the ferritin level is normal, the repeat ferritin for dia When an End Stage Renal Disease (ESRD) patient is tested for ferritin, testing more frequently than every three months requires documentation of medical necessity (e. In young Ferritin - Useful in the diagnosis of hypochromic, microcytic anemias. When appropriate, obtain a properly executed ABN and submit the ABN with test order (s). Local Coverage Determination (LCD) CPT Code: 82728 State: None Selected The following Medicare contractor (s) are active in the coverage area you selected. This Content Might Be Outdated - Check in Our Free Code Lookup Tool Medical codes change frequently, and using outdated information can lead to denials. Codes for Serum Iron Studies CPT codes: Code Description 82728 Ferritin 83540 Iron 83550 Iron binding capacity 84466 … for serum ferritin for anemia screening when billed with 82728. Jun 23, 2025 · Understanding the CPT code for ferritin (82728) is essential for healthcare providers, medical coders, and billing specialists to ensure accurate claims and reimbursements. This approach focuses attention on biochemical individuality, metabolic balance, ecological context and unique personal experience in the dynamics of health. Iron studies are best performed when the patient is fasting in the morning and has abstained from medications that may influence iron balance. These guidelines address hundreds of medical issues, including diagnostic and therapeutic procedures, injectable drugs, and durable medical equipment. Oct 1, 2021 · Serum Iron Studies CPT: 82728, 83540, 83550, 84466 CMS National Coverage Policy Coverage Indications, Limitations, and/or Medical Necessity When an End Stage Renal Disease (ESRD) patient is tested for ferritin, testing more frequently than every three months requires documentation of medical necessity (e. CMS itself established national policies and effective November 25, 2002, implemented the National Coverage Determinations (NCDs). All rights reserved. . ICD-10-CM Diagnosis Coding The above medical necessity criteria MUST be met for the following codes to be covered for Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity. Medical Necessity. Key Use: This is the primary code for standalone ferritin testing performed in a laboratory setting. Min 0. Decreased in iron deficiency anemia and increased in iron overload. Many other conditions secondarily affect the blood or bone marrow, including reaction We would like to show you a description here but the site won’t allow us. Jul 30, 2025 · Policies Local Coverage Determination (LCD) Billing and Coding Articles Clinician’s Corner Medical Director Articles Molecular Diagnostic Services National Coverage Determination (NCD) Noridian Medical Directors Self Administered Drugs (SADs) Medical policies are used by all plans and lines of business unless Federal or State law — as well as contract language, including definitions and specific contract provisions or exclusions — take precedence over a medical policy. Background Functional medicine is the discipline of healthcare that utilizes laboratory assessment and early intervention to improve physiological, emotional/cognitive, and physical function. Coverage Indications, Limitations, and/or Medical Necessity Serum iron studies are useful in the evaluation of disorders of iron metabolism, particularly iron deficiency and iron excess. This type of search will return all documents containing the CPT/HCPCS code. Tests subject to an MLCP must meet medical-necessity criteria in order to be covered by Medicare. Repeat fFN performed for the suspicion of hemochromatosis. Feb 3, 2025 · What is an LCD?Local coverage determinations (LCDS) are defined in Section 1869 (f) (2) (B) of the Social Security Act (the Act). Ensure you're working with the most up-to-date version of CPT Code 82728 by opening it in our free code lookup tool. Ferritin - Useful in the diagnosis of hypochromic, microcytic anemias. See Attachment Section for ICD-10 Codes approved with CPT code 82728, 83540, 83550, and/or 84466 (Serum Iron We would like to show you a description here but the site won’t allow us. Highmark's medical policy guidelines address both clinical and claim payment reimbursement issues. ICD-10-CM code: For example, "E08. In cases where medical necessity is not established by policy for specific treatment modalities, evidence not previously considered regarding the efficacy of the modality that is presented shall be given consideration to determine if the policy represents current standards of care. We would like to show you a description here but the site won’t allow us. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. ICD10 CPT codes 82728 83540 83550 and or 84466 Serum Iron Code ICD10 CPT codes 82728 83540 83550 and or 84466 Serum Iron Code A01. This controlled release is essential for maintaining the body's iron balance, preventing both iron overload and Discover how Cigna Healthcare coverage policies can help providers interpret health coverage plan provisions. CPT Code 82306, Vitamin D Testing Vitamin D is a hormone, synthesized by the skin and metabolized by the kidney to an active hormone, calcitriol. Coverage policies are intended to provide guidance in interpreting certain standard Cigna benefit plans and are used by medical directors and other health care professionals in making medical necessity and other coverage determinations. Oct 1, 2025 · Blood ferritin concentration appears to be reasonably sensitive and a very specific test for iron deficiency in people presenting for medical care, but the reviewers reported that the findings are based on evidence of low-certainty. Medicare coverage & coding guides Medicare has limited coverage policies (MLCPs) for certain laboratory tests. Consider claims that match on the following items as duplicates The service was performed by the same provider, For the same beneficiary, and For the same date of service. CPT code information is copyright by the AMA. In coding scenarios where there appears to be conflicts between sources, we will apply the edits we determine are appropriate. 04 A01 Tests with Medical Necessity PoliciesSearch GENERAL INFORMATION AND RULES 1. 1, Pure hyperglyceridemia). The CMS web site is available to assist you with this verification. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements. Methodology: Chemiluminescence Assay Test Code: 457 CPT Code (s):82728 Includes: Ferritin Methodology: Immunoassay (IA) Clinical Significance: Useful in the diagnosis of hypochromic, microcytic anemias. g. Medicare Medical Necessity The Centers for Medicare and Medicaid Services (CMS) requires Medicare Administrative Contractors (MAC) to establish policies to ensure the medical necessity of services being paid for by the Medicare program. Reimbursement is limited to indicated uses of procedures that are FDA approved for in vitro diagnostic use or We would like to show you a description here but the site won’t allow us. Unlock the details of cpt code 80061, your guide to billing and understanding lipid panel tests for cholesterol and heart health management. 01 A01. Mar 18, 2014 · March 18, 2014 Laboratory Services: Medical Necessity and National Coverage Determinations (NCDs) The Centers for Medicare & Medicaid Services (CMS) created 23 National Coverage Determinations (NCDs) for specific clinical laboratory tests, including the tests listed above. Medical Necessity Aetna considers the fetal fibronectin (fFN) immunoassay test medically necessary for evaluating symptomatic pregnant women at high-risk for preterm delivery (see background section for selection criteria). Iron Deficiency Anemia (IDA) Definition For the purposes of this policy, iron deficiency anemia (IDA) is defined as the following (unless otherwise specified in the policy): Search Show all My searches = Diagnosis Supports Medical Necessity Codes: 3264 - Page 1 of 327 - Per Page: [ 1 2 3 4 5 6 7 8 9 10 ] Next : Last The Medicare, Medicaid, Commercial, and Pharmacy Coverage Policies found here describe Humana's evaluation and coverage of medical procedures, devices, and medications. Text: Useful for the diagnosis of iron deficiency and iron-overload conditions. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy. In some patients presenting with certain signs, symptoms or diseases, a single CBC may be appropriate. The CPT 82728 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. Ferritin is a crucial intracellular protein that plays a significant role in iron metabolism by storing iron and regulating its release into the bloodstream. Description Serum iron studies are useful in the evaluation of disorders of iron metabolism, particularly iron deficiency and iron excess. When a blood count is performed for an end-stage renal disease (ESRD) patient, and is billed outside the ESRD rate, documentation of the medical necessity for the blood count must be submitted with the claim. If you do not submit claims to the contractor listed below, the policy may be useful for guidance on appropriate billing. Learn test uses, billing rules, and how OptiMantra streamlines lab management. Patterns of billing will be monitored for potential utilization of these tests for screening purposes, either by use of a single test or multiple tests together. Because ferritin level can be affected by clinical conditions other than iron disorders, the measurement of transferrin saturation-calculated from serum iron level and total iron binding capacity (TIBC)-in the same serum specimen may facilitate the diagnosis of iron deficiency or overload Mar 25, 2021 · Find Horizon Blue Cross Blue Shield New Jersey reimbursement policies and guidelines for maternity, dental, anesthesia, co-surgeon and more Iron, TIBC and Ferritin Panel - This serum iron study panel may help diagnose iron deficiency or overload. Coverage Indications, Limitations, and/or Medical Necessity Notice: It is not appropriate to bill Medicare for services that are not covered (as described by this entire LCD) as if they are covered. List the principal diagnosis for the medical service or procedure. , other than Chronic Renal Failure (ICD-9-CM 585) or Renal Failure, Unspecified (ICD-9-CM 586)]. This process permits the identification of CPT codes subject to local medical review policies. 3, Fiscal Intermediary manual) requires documentation of medical necessity [e. Nov 12, 2025 · CPT 82728 measures ferritin levels to assess iron storage, anemia, or inflammation. CMS and Medicare contractor information may change at any time. Determine medical necessity. Serum Iron Studies CPT Code 82728, 83540, 83550, 84466are Local Coverage Determination Policy The ICD10 codes listed below are the top diagnosis codes currently utilized by ordering physicians for the limited coverage test highlighted above that are also listed as medically supportive under Medicare’s limited coverage policy. This section states: “For purposes of this section, the term ‘local coverage determination' means a determination by a fiscal intermediary or a carrier under part A or part B, as applicable, respecting whether or not a particular item or service is covered on an Jul 24, 2025 · Understand how medical necessity impacts care, coding, and reimbursement – and how health systems can avoid denials and compliance risks. Policy Scope of Policy This Clinical Policy Bulletin addresses fetal fibronectin, inflammatory biomarkers, and salivary hormone testing for preterm labor. Test Classification and CPT Coding 82728 - Ferritin LCD or NCD test. The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. Aug 9, 2025 · Ferritin Test (CPT 82728) – Assesses iron storage in tissues. All unlisted codes are reviewed for medical necessity, correct coding, and pricing at the claim level. The Current Procedural Terminology (CPT ®) code 83550 as maintained by American Medical Association, is a medical procedural code under the range - Chemistry Procedures. One of the fundamental aspects of accurate medical coding lies in the understanding and application of modifiers. Please note the terms of a customer’s particular 3 days ago · CPT ® Code Set 82728 - CPT® Code in category: Chemistry Procedures CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. How To Use CPT Code 86140 This Content Might Be Outdated - Check in Our Free Code Lookup Tool Medical codes change frequently, and using outdated information can lead to denials. These include primary disorders such as anemia, leukemia, polycythemia, thrombocytosis and thrombocytopenia. Serum iron studies are useful in the evaluation of disorders of iron metabolism, particularly iron deficiency and iron excess. Medical policy determines if, and under what circumstances, medical services may be eligible for coverage. When elevated, serum concentration of markers may reflect tumor size & grade. This section states: “For purposes of this section, the term ‘local coverage determination' means a determination by a fiscal intermediary or a carrier under part A or part B, as applicable, respecting whether or not a particular item or service is covered on an Jun 23, 2025 · Understanding the CPT code for ferritin (82728) is essential for healthcare providers, medical coders, and billing specialists to ensure accurate claims and reimbursements. Learn how to access them effectively. May 26, 2023 · The Comprehensive Guide to CPT Code 82670: Estradiol;total with Modifiers: Demystifying the Usage of Modifiers in Medical Coding Navigating the intricacies of medical coding can be daunting, especially for those new to the field. Previously Listed as Edit 7 Description Serum iron studies are useful in the evaluation of disorders of iron metabolism, particularly iron deficiency and iron excess. ICD-10 LCD Policies We would like to show you a description here but the site won’t allow us. Medical Policies This section contains Medical Policies approved by Blue Cross and Blue Shield of Kansas City (“BCBSKC”). MACs will approve payment CPT Codes for Ferritin Testing Primary CPT Code for Ferritin Testing CPT 82728: Ferritin; quantitative. For Statement of Medical Necessity (SMN) precertification forms, see Specialty Pharmacy Precertification. Note: For commercial plans, Site of Care Utilization Management Policy applies for Briumvi, Lemtrada, Ocrevus, Ocrevus Zunovo, Tyruko, and We would like to show you a description here but the site won’t allow us. Alternative Name (s): N/A The Blue Cross and Blue Shield of Texas (BCBSTX) Medical Policy manual contains Medical Policies used by Blue Cross Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. 00 A01. Evaluating organ "function" versus organ We would like to show you a description here but the site won’t allow us. Ensure you're working with the most up-to-date version of CPT Code 83735 by opening it in our free code lookup tool. CMS National Coverage Policy Coverage Indications, Limitations, and/or Medical Necessity Blood counts are used to evaluate and diagnose diseases relating to abnormalities of the blood or bone marrow. 5 mL. Because ferritin level can be affected by clinical conditions other than iron disorders, the measurement of transferrin saturation-calculated from serum iron level and total iron binding capacity (TIBC)-in the same serum specimen may facilitate the diagnosis of iron deficiency or overload Aug 19, 2024 · Use Codify for fast CPT code lookup and search. Coding & Compliance CDM 01481267, 01420020, 01423550 CPT Coding 82728, 83540, 83550 Medical Necessity May Apply All unlisted codes are reviewed for medical necessity, correct coding, and pricing at the claim level. Access CPT codes and get help in describing exactly what service a healthcare provider has performed. For ICD-10 Codes approved with CPT code 82728, 83540, 83550, and/or 84466 (Serum Iron Studies), see the Attachment Section. A claim submitted for payment of a test on a local or national list without a specific Jun 26, 2025 · This guide provides an in-depth look at CPT code for iron testing and infusions, covering lab tests, infusion therapies, billing guidelines, and common conditions requiring iron management. CPT/HCPCS codes are only included in Articles and certain Durable Medical Equipment (DME) LCDs, or possibly in retired versions of LCDs. Feb 1, 2025 · Instructions for use The following coverage policy applies to health benefit plans administered by Cigna. Sep 24, 2004 · The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 requires that the Secretary make available to the public the factors that are considered in making National Coverage Determinations (NCDs) of whether an item or service is reasonable and necessary. Frequency limitations do not establish medical necessity for all testing but does reflect how the medical community uses the tests. See “Medical Necessity and Advanced Beneficiary Notice (ABN) Policy and Form” under "Resources” for a copy of a form and additional information. This guide explores CPT coding, clinical applications, and billing considerations for iron and TIBC testing, ensuring accurate diagnosis and reimbursement. Serum folate testing (Current Procedural Terminology [CPT®] code 82746) is considered medically necessary for EITHER of the following: Suspected diagnosis of folate deficiency associated with ANY of the following: We would like to show you a description here but the site won’t allow us. We follow coding edits that are based on industry sources, including, but not limited to, CPT® guidelines from the American Medical Association, specialty organizations, and CMS including NCCI and MUE. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. The Clinical A lipid panel (CPT code 80061) at a yearly interval will usually be adequate while measurement of the serum total cholesterol (CPT code 82465) or a measured LDL (CPT code 83721) should suffice for interim visits if the patient does not have hypertriglyceridemia (for example, ICD-9-CM code 272. Ensure you're working with the most up-to-date version of CPT Code 86140 by opening it in our free code lookup tool. CPT Code (s) / Price estimate Code (s) / Medical Necessity Information CPT Code (s): 82728 SCHS pricing estimate procedure code (s): HC FERRITIN [3010082728] **if appropriate CPT® 36415 - HC BLOOD DRAW VENIPUNCTURE [3000036415] Medical Necessity - Medicare NCD : Serum Iron Studies NCD for Serum Iron Studies Applicable CPT Code(s): 82728 – Ferritin 83540 – Iron 83550 – Iron Binding capacity 84466 – Transferrin This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. 0 mL serum from SST, refrigerated. This Fact Sheet identifies the indications and limitations of Medicare coverage and reimbursement for these services. This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms. MLCP tests ordered without a supportive ICD-10 code will not satisfy medical necessity and therefore will not be covered by Medicare. For precertification of multiple sclerosis medications, call (866) 752-7021 or fax (888) 267-3277. The fees in the Laboratory Fee Schedule apply to clinical laboratory tests selected from Physician's Current Procedural Terminology (CPT), Professional Edition, 2016 or the Healthcare Common Procedure Coding System (HCPCS), Professional Edition, 2016. If an unlisted code is submitted for non-covered services addressed in this policy then it will be denied as not covered. Oct 1, 2021 · Serum Iron Studies CPT: 82728, 83540, 83550, 84466 CMS National Coverage Policy Coverage Indications, Limitations, and/or Medical Necessity billing CPT 82728 & covered DX CPT Code: 82728 Serum Iron Studies Frequency Limitations: If a normal serum ferritin level is documented, repeat testing would not ordinarily be medically necessary unless there is a change in the patient's condition, and ferritin assessment is needed for the ongoing management of the patient. , other than chronic renal failure or renal failure, unspecified). Medical Policy By clicking on “I Agree” below, I acknowledge that I have read the following. The Current Procedural Terminology (CPT ®) code 82728 as maintained by American Medical Association, is a medical procedural code under the range - Chemistry Procedures. ICD-10 code is required for this test. 621". Medical Policies are based on research that provides evidence of scientific merit for a particular medical We would like to show you a description here but the site won’t allow us. How To Use CPT Code 83735 This Content Might Be Outdated - Check in Our Free Code Lookup Tool Medical codes change frequently, and using outdated information can lead to denials. Those provisions will be considered first in determining eligibility for coverage before the medical policy is used to determine medical necessity. Ferritin Test ID: FER CPT code: 82728 LOINC: 2276-4 Specimen Type: SERUM Frequency: Setup: Sun- Fri, Analytic time:1-3 days Instructions: 1. Mar 25, 2021 · Find Horizon Blue Cross Blue Shield New Jersey reimbursement policies and guidelines for maternity, dental, anesthesia, co-surgeon and more Iron, TIBC and Ferritin Panel - This serum iron study panel may help diagnose iron deficiency or overload. Search our policy database for information about treatments and procedures, including Anthems definition, position, and rationale. 02 A01. This test, when ordered on Medicare patients, is subject to the National Coverage Determination (NCD) policies. The Current Procedural Terminology (CPT ®) code 85730 as maintained by American Medical Association, is a medical procedural code under the range - Hematology and Coagulation Procedures. UnitedHealthcare Individual Exchange will not reimburse when the treatment rendered is without inclusion of one of the ICD-10-CM diagnostic codes being included on the claim accurately reflecting the member's condition. Search for medical policies and medical policy guidelines, find out what Highmark and Medicare Advantage medical policies cover, and more. Medicare Medical Necessity As an informational service to Labcorp accounts, this page contains certain Local Coverage Determinations (LCDs) issued by the Medicare Administrative Contractors (MACs) and National Coverage Determinations (NCDs) issued by the Centers for Medicare & Medicaid Services (CMS). We use industry-standard claims editing software products when We would like to show you a description here but the site won’t allow us. Providers should follow the policies of the Medicare contractor you submit your claims to. CPT® CODE 82728 Details CPT® 2024 American Medical Association. The Current Procedural Terminology (CPT ®) code 83540 as maintained by American Medical Association, is a medical procedural code under the range - Chemistry Procedures. Lay Term: Measures the concentration of ferritin in the blood to assess iron storage levels. Apr 5, 2019 · To support medical necessity for services reported, apply the following principles: 1. Iron studies are best performed when the patient is fasting We would like to show you a description here but the site won’t allow us. Statement on Medical Necessity All ordered tests should be medically necessary for the diagnosis or detection of disease, illness, impairment, symptom, syndrome, or disorder and the results should be used in the medical management and treatment decisions for the patient. When billing for non-covered services, use the appropriate modifier. When an End Stage Renal Disease (ESRD) patient is tested for ferritin, testing more frequently than every three months (the frequency authorized by 3167. Documentation Requirements Documentation supporting medical necessity should be legible, maintained in the patient’s medical record and made available upon request. Please verify that the diagnosis code (ICD code) you have chosen demonstrates medical necessity for the test as documented in the physician’s patient record. Common Language Description The CPT® Code 82728 refers to the laboratory test for measuring ferritin levels in the blood. Medical policies and clinical UM guidelines help us determine if a procedure is medically necessary. Oct 1, 2022 · MEDICALLY NECESSARY ICD 10 CODES FOR COBALAMIN (VITAMIN B12) AND/OR FOLIC ACID TESTING (CPT CODES 82607, 82608, 82746, AND 82747) The Current Procedural Terminology (CPT ®) code 82607 as maintained by American Medical Association, is a medical procedural code under the range - Chemistry Procedures. 03 A01. Process Claims. Vitamin D deficiency may lead to a variety of disorders. on of disorders of iron metabolism, particularly iron deficiency and iron excess. nvrug nusp iyfeouc dul jvtrhzai xkaqhb mxwaxgx luibi llzjrb oyklej wnfxyi jwrpfm inzunxpbw cayq cxr