Frequency Limitations:
Testing may be covered up to two times a year in clinically stable patients; more frequent testing may be reasonable and necessary for patients whose thyroid therapy has been altered or in whom symptoms or signs of hyperthyroidism or hypothyroidism are noted.
CPT CODES: 80091 Thyroid panel, includes Thyroxine, total (84436) and Thyroid
hormone (T3 or T4) uptake or thyroid hormone binding ration (84479)
80092 Thyroid panel with TSH
84436 Thyroxine, total
84439 Thyroxine Free
84443 Thyroid Stimulating Hormone (TSH)
84479 Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR)
CMS (Medicare) has determined that Thyroid Testing (CPT Codes 84436, 84439, 84443, 84479) is only medically necessary and, therefore, reimbursable by Medicare when ordered for patients with any of the diagnostic conditions listed below in the “ICD-9-CM Codes Covered by Medicare Program.” If you are ordering this test for a diagnostic condition other than those listed below, please have your patient sign and date an Advanced Beneficiary Notice (ABN). All ICD-9-CM codes provided must be consistent with the documentation in the patient’s medical records for the date of service.
CPT CODE(S) TEST NAME MANUFACTURER USE 84443QW
1. Aventir Biotech LLC, Forsure TSH Test {Whole Blood} Screening Devices Canada Inc. Qualitative determination of human thyroid stimulating hormone (TSH) in
whole blood, which is a rapid TSH assay for hypothyroidism screening in adults
2. BTNX, Rapid Response Thyroid Stimulating Hormone (TSH) Test Cassette Screening Devices Canada Inc.
3. BTNX, Inc Rapid Response Thyroid Stimulating Hormone (TSH) Test Cassette Screening Devices Canada Inc.
4. CLIAwaived Inc. Thyroid Test Rapid TSH Cassette {Whole Blood} Screening Devices Canada Inc.
5. Germaine Laboratories, Inc. AimStep Thyroid Screen {whole blood} Screening Devices Canada Inc.
6. ThyroTec, Inc. ThyroTest Whole Blood TSH Test ThyroTec, Inc.
7. Jant Pharmacal Accutest TSH {Whole Blood} Screening Devices Canada Inc.
8. Qualigen, Inc. FastChek TSH {Whole blood} Screening Devices Canada Inc.
84450QW, 84520QW Arkray SPOTCHEM EZ Chemistry Analyzer{whole blood} Arkray, Inc. Quantitative determination of blood urea nitrogen (BUN) and aspartate minotransferase in whole blood 84450QW Cholestech LDX Aspartate Aminotransferase (AST)(SGOT) Cholestech Corporation Quantitative determination of aspartate aminotransferase in whole blood 84460QW Cholestech LDX? Alanine Aminotransferase (ALT) Test Cholestech Corporation Quantitative determination of alanine aminotransferase in whole blood 84703QW Bayer Clinitek 50 Urine Chemistry Analyzer – for HCG, urine Bayer Corp. Diagnosis of pregnancy 85014QW Wampole STAT-CRIT Hct Wampole Laboratories Screen for anemia 85018QW
1. AimStrip Hb Hemoglobin (Hb) Testing System Acon Laboratories, Inc. Measures hemoglobin level in whole blood
2. Alere HemoPoint H2 System Stanbio Laboratory
ICD 10 Code Description
D64.9 Anemia, unspecified
E03.8 Other specified hypothyroidism
E03.9 Hypothyroidism, unspecified
E05.90
Thyrotoxicosis, unspecified without thyrotoxic crisis or
storm
E07.9 Disorder of thyroid, unspecified
E11.65 Type 2 diabetes mellitus with hyperglycemia
E11.9 Type 2 diabetes mellitus without complications
E78.0 Pure hypercholesterolemia
E78.2 Mixed hyperlipidemia
E78.4 Other hyperlipidemia
E78.5 Hyperlipidemia, unspecified
F32.9 Major depressive disorder, single episode, unspecified
I10 Essential (primary) hypertension
I48.91 Unspecified atrial fibrillation
I50.9 Heart failure, unspecified
R53.81 Other malaise
R53.82 Chronic fatigue, unspecified
R53.83 Other fatigue
R63.4 Abnormal weight loss
Z79.899 Other long term (current) drug therapy
COVERED DIAGNOSIS:
193 Malignant neoplasm of thyroid gland
198.82 Secondary malignant neoplasm of genital organs
198.89 Secondary malignant neoplasm of other specified site
226 Benign neoplasm of thyroid glands
227.3 Pituitary gland and craniopharyngeal duct (pouch)
234.8 Carcinoma in situ of other specified sites
237.0 Neoplasm of uncertain behavior of pituitary gland and craniopharyngeal duct
237.4 Neoplasm of uncertain behavior of other and unspecified endocrine glands
239.7 Neoplasm of unspecified nature, endocrine glands and other parts of nervous system
240.0-240.9 Simple and unspecified goiter
241.0-241.9 Nontoxic nodular goiter
242.00-242.91 Thyrotoxicosis with or without goiter
243 Congenital hypothyroidism
244.0-244.9Acquired hypothyroidism
245.0-245.9Thyroiditis
246.0-246.9Other disorders of thyroid
252.1Hypoparathyroidism
253.1 Other and unspecified anterior pituitary hyperfunction
253.2 Panhypopituitarism
253.3 Pituitary dwarfism
253.4 Other anterior pituitary disorders
253.7 Iatrogenic pituitary disorders
255.2 Adrenogenital disorders
255.3 Other corticoadrenal overactivity
255.4 Corticoadrenal insufficiency
256.3 Other ovarian failure
257.2 Other testicular hypofunction
258.0-258.9 Polyglandular activity in multiple endocrine adenomatosis, up to and including
polyglandular dysfunction, unspecified
266.0 Deficiency of B-complex components ariboflavinosis
272.0 Pure hypercholesterolemia
272.1 Pure hyperglyceridemia
272.2 Mixed hyperlipidemia
272.4 Other and unspecified hyperlipidemia
275.40-275.49 Disorders of calcium metabolism
276.1 Hyposmolality and/or hyponatremia
278.00 Obesity, unspecified
278.01 Morbid obesity
290.0 Senile dementia, uncomplicated
290.10-290.13 Presenile dementia
290.20-290.21 Senile dementia with delusional or depressive features
290.3 Senile dementia with delirium
292.89 Other specified drug-induced mental disorders
293.0-293.1 Acute and subacute delirium
293.81-293.89 Other specified transient organic mental disorders
293.9 Unspecified transient organic mental disorders
294.0 Amnestic syndrome
294.10-294.11 Dementia in conditions classified elsewhere
294.8 Other specified organic brain syndromes (chronic)
294.9 Unspecified organic brain syndrome (chronic)
295.00-295.95 Schizophrenic disorders
296.00-296.99 Affective psychoses
297.1 Paronoia
298.8 Other and unspecified reactive psychosis
298.9 Unspecified psychosis
300.00-300.02 Anxiety states, up to generalized anxiety disorder
300.81 Somatization disorder
301.13 Cyclothymic disorder
307.1 Anorexia nervosa
307.51 Bulimia
310.1 Organic personality syndrome
311 Depressive disorder, not elsewhere classified
331.0-331.2Other cerebral degenerations
333.1 Essential and other specified forms of tremor
333.5 Other choreas
354.0 Carpal tunnel syndrome
356.9 Hereditary and idiopathic peripheral neuropathy, unspecified
357.8 Inflammatory and toxic neuropathy; other
358.1 Myasthenic syndromes in diseases classified elsewhere
359.5 Myopathy in endocrine diseases classified elsewhere
368.2 Diplopia
374.41 Lid retraction or lag
374.82 Edema of eyelid
376.21 Thyrotoxic exophthalmos
376.22 Exophthalmic ophthalmoplegia
376.30 Exophthalmos, unspecified
376.31 Constant exophthalmos
376.33 Orbital edema or congestion
376.34 Intermittent exophthalmos
376.35 Pulsating exophthalmos
389.10-389.18 Sensorineural hearing loss
389.2 Mixed conductive and senorineural hearing loss
401.0-401.9 Hypertension
423.9 Unspecified disease of pericardium
425.7 Nutritional and metabolic cardiomyopathy
427.0 Paroxysmal supraventricular tachycardia
427.2 Paroxysmal tachycardia, unspecified
427.31 Atrial fibrillation
427.32 Atrial flutter
427.60-427.61 Premature beats
427.81-427.89 Other specified cardiac dysrhythmias
427.9 Cardiac dysrhythmia, unspecified
428.0 Congestive heart failure
428.1 Left heart failure
429.2 Cardiovascular disease, unspecified
429.3 Cardiomegaly
560.1 Paralytic ileus
564.0 Constipation
564.5 Functional diarrhea
564.7 Megacolon, other than Hirschsprung’s
611.1 Hypertrophy of breast
611.6 Galactorrhea not associated with childbirth
625.3 Dysmenorrhea
626.0-626.2 Disorders of menstruation and other abnormal bleeding, female genital tract
626.4 Irregular menstrual cycle
626.6 Metrorrhagia
626.8 Disorders of menstruation and other abnormal bleeding from female genital tract, other
648.10-648.14 Other current conditions in the mother, classifiable elsewhere, but complicating
pregnancy, childbirth, or the puerperium, thyroid dysfunction
676.20-676.24 Engorgement of breast associated with childbirth and disorders of lactation
698.9 Pruritus
701.1 Keratoderma, acquired (dry skin)
703.8 Other specified diseases of nail (brittle nails)
704.00 Alopecia, unspecified
709.01 Vitiligo
710.0 Systemic lupus erythematosus
710.1 Systemic sclerosis
710.2 Sicca syndrome
714.0 Rheumatoid arthritis
716.90-716.99 Arthropathy, unspecified
728.9 Unspecified disorder of muscle, ligament, and fascia
729.1 Myalgia and myositis, unspecified
729.82 Cramp
730.30-730.39 Periostitis without mention of osteomyelitis
733.00-733.03 Osteoporosis
733.09 Osteoporosis, drug induced
750.15 Macroglossia
759.2 Anomalies of other endocrine glands
775.3 Neonatal thyrotoxicosis
780.09 Alteration of consciousness, other
780.1 Hallucinations
780.51-780.53 Sleep disturbances
780.57 Other and unspecified sleep apnea
780.79 Other malaise and fatigue
780.8 Hyperhidrosis
780.9 Malaise and fatigue, other general symptoms
781.0 Abnormal involuntary movements
781.3 Lack of coordination
782.3 Edema
782.8 Changes in skin texture
783.1 Abnormal weight gain
783.21 Abnormal loss of weight
784.1 Throat pain
784.49 Voice disturbance, other
785.0 Tachycardia, unspecified
785.1 Palpitations
787.2 Dysphagia
787.99 Other symptoms involving digestive system, other
790.6 Other abnormal blood chemistry, lithium
793.2 Other intrathoracic organ
794.5 Nonspecific abnormal results, thyroid
796.1 Abnormal reflex
799.2 Nervousness
990 Effects of radiation, unspecified
995.2 Unspecified adverse effect of drug, medicinal and biological substance
V10.87 Personal history of malignant neoplasm of thyroid
V18.1 Other endocrine and metabolic diseases
V58.69 Long term (current) use of other medications
V77.7 Other inborn errors of metabolism
