82523
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- No specific documentation requirements for ordering or coverage of BTMs are provided in this policy.
- General instruction: when deciding coverage, reference the member-specific benefit plan document as terms may differ from the standard plan; in the event of conflict, the member-specific benefit plan governs.
- If a claim is submitted, supporting medical records demonstrating medical necessity per the member's benefit plan and any applicable federal/state mandates should be provided (e.g., clinical notes, indications for testing, prior treatments) — policy emphasizes reliance on member-specific plan and applicable laws.
- Policy notes that FDA cleared commercially marketed tests exist and that laboratories using laboratory-developed tests are subject to CLIA, but FDA clearance alone is not a basis for coverage.
Key Coverage Criteria
- None — Serum or urine collagen crosslinks or biochemical markers of bone turnover are considered unproven and NOT medically necessary for: assessing risk of fracture, predicting bone loss, or assessing response to antiresorptive therapy (Coverage Rationale).
- No biochemical markers of bone remodeling are identified in this Clinical Policy Bulletin as established/covered for evaluation of fracture risk; Aetna considers measurement of the listed bone turnover markers for evaluating fracture risk experimental and investigational.
- Aetna considers measurement of the following specific bone turnover markers experimental and investigational for evaluating fracture risk (list not all-inclusive): Bone sialoprotein; Cathepsin K; Cobalamine (Vitamin B12); Dickkopf-related protein 1 (DKK-1); Hydroxyproline; Insulin-like growth factor-1 (IGF-1); Osteocalcin; Osteoprotegerin; Procollagen type I amino terminal propeptide (P1NP); Pyridinium crosslinks (pyridinoline, deoxypyridinoline); Receptor activator of nuclear factor kappa-B lig [...]
- No biochemical markers (including serum or urinary collagen crosslinks or other BTMs) are established/covered for routine screening, diagnosis, or management of osteoporosis according to this CPB.
- Aetna considers measurement of bone turnover markers experimental and investigational for diagnosis and monitoring of aseptic loosening and/or osteolysis related to wear or corrosion in total joint arthroplasty.
- Aetna considers measurement of bone turnover markers experimental and investigational for persons receiving serotonergic antidepressants (i.e., NOT established/covered for evaluating bone effects in this population).
10 Active Policies
UMR-POL-UMR-collagen-crosslinks-biochemical-markers-bone-turnover — Collagen Crosslinks and Biochemical Markers of Bone Turnover
SUREST-POL-SUREST-collagen-crosslinks-biochemical-markers-bone-turnover — Collagen Crosslinks and Biochemical Markers of Bone Turnover
UHC-POL-collagen-crosslinks-biochemical-markers-bone-turnover — Collagen Crosslinks and Biochemical Markers of Bone Turnover
AETNA-CPB-0562 — Biochemical Markers of Bone Remodeling
Related Codes
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