82610
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
- Claims should be supported with documentation consistent with LCD L36129; this article provides billing and coding guidelines that complement that LCD and should be used alongside the LCD when submitting claims.
- Maintain a legible medical record for each patient that includes complete patient identification (e.g., full name, dates of service) and is available to the contractor upon request.
- Medical records must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
- The submitted medical record must support the use of the selected ICD-10-CM code(s) and the medical necessity of the cystatin C test as directed in the related LCD (L37581).
Key Coverage Criteria
- Cystatin C measurement is covered when performed on an adult (age >=18) patient with a creatinine-based eGFR of 45–59 ml/min/1.73 m2 and who does not have markers of kidney damage.
- Cystatin C measurement is covered when the medical record documents a clear rationale that creatinine-based eGFR estimates are thought to be inaccurate and that more accurate knowledge of GFR will affect clinical decision-making or the patient’s plan of care.
- Cystatin C measurement is covered for adult patients (age >=18) with creatinine-based eGFR 45–59 ml/min/1.73 m2 who do not have markers of kidney damage.
- Cystatin C measurement is covered when documentation shows creatinine-based GFR estimates are believed to be inaccurate and more accurate GFR knowledge will affect clinical decision making or the patient's plan of care.
- No clinical indications are specified in this article; coverage indications are determined by the referenced LCD L36362 (MolDX: Biomarkers in Cardiovascular Risk Assessment).
- This article contains billing and coding guidance only and does not itself define clinical indications; refer to MolDX: Biomarkers in Cardiovascular Risk Assessment LCD L36139 for covered clinical indications.
19 Active Policies
A57559 — Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment
J05
L36523 — MolDX: Biomarkers in Cardiovascular Risk Assessment
J05
A57682 — Billing and Coding: Cystatin C Measurement
J09
L37561 — Cystatin C Measurement
J09
A57055
Related Codes
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