83937
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
- Implicit: because the CPB deems the listed uses experimental/investigational, documentation showing medical necessity for non‑experimental, evidence‑based indications is not described or endorsed.
- No specific documentation requirements, test result thresholds, or required clinical record elements are specified in this policy bulletin for covered use. (Policy treats the listed measurements as experimental/investigational and not covered.)
- Laboratory tests are not covered unless they are ordered by a physician or other qualified health professional. Please check benefit plan descriptions.
- For use of late-night salivary cortisol in diagnosing Cushing's syndrome: exclude exogenous glucocorticoid use and perform testing in patients with multiple and progressive features compatible with the syndrome and patients with adrenal incidentaloma (per Endocrine Society guideline text in policy).
Key Coverage Criteria
- 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).
- Aetna considers measurement of collagen crosslinks experimental and investigational for screening, diagnosis, or management of bisphosphonate-induced jaw osteonecrosis, chronic kidney disease, osteogenesis imperfecta, or other indications.
8 Active Policies
AETNA-CPB-0562 — Biochemical Markers of Bone Remodeling
AETNA-CPB-0608 — Salivary Tests
BCBSIL-MED207.116 — Bone Turnover Markers for Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover
BCBSMT-MED207.116 — Bone Turnover Markers for Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover
BCBSNM-MED207.116 — Bone Turnover Markers for Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.