83525
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
- Clinical documentation of measured stature and serial height velocity.
- Documentation comparing the patient's stature/height velocity to genetic/familial potential and pubertal stage to justify endocrine testing.
- Clinical rationale/notes supporting why endocrine evaluation is being ordered (e.g., growth attenuation findings).
- For Medicare members/enrollees, review and ensure consistency with applicable Medicare NCDs, LCDs, and Medicare Coverage Articles prior to applying this policy's criteria.
Key Coverage Criteria
- Quantification of thyroid hormone levels (e.g., TSH, T4) to assess thyroid function when clinically indicated.
- Evaluation of suspected thyroid dysfunction in pediatric patients with clinical signs or symptoms of thyroid disease (interpret results with caution in overweight/obese children).
- Laboratory evaluation for endocrine etiologies of pediatric obesity when the patient's stature and/or height velocity are attenuated relative to genetic/familial potential and pubertal stage.
- Body mass index (BMI) measurement is the recommended screening test for obesity.
- For children, plot BMI percentile on age- and sex-specific CDC growth charts; obesity is defined as BMI at or above the 95th percentile.
- Morbid (severe) obesity due to excess calories (E66.01)
1 Active Policy
AMBETTER-CP.MP.154 — Thyroid Hormones and Insulin Testing in Pediatrics
Related Codes
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