83970
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
- Maintain all documentation in the patient's medical record and make it available to the contractor upon request; every page must be legible and include patient identification and dates of service.
- The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient's care.
- The submitted medical record must support the use of the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must describe the service performed.
- If the service provider is not the ordering/referring physician, that provider must maintain hard-copy documentation of test results and interpretation plus copies of the ordering/referring physician’s order.
Key Coverage Criteria
- Parathormone (parathyroid hormone) testing is covered when medical necessity and reasonable-and-necessary criteria specified in Local Coverage Determination L34018 are met.
- For renal dialysis facilities submitting claims for parathormone testing, use diagnosis code N18.6 (end stage renal disease).
- PTH testing is covered for evaluation of patients with a prior diagnosis of hyperparathyroidism or hypoparathyroidism.
- PTH testing is covered to evaluate a patient with an abnormal total serum calcium level.
- PTH testing is covered to distinguish parathyroid from non-parathyroid causes of hypercalcemia.
- PTH testing is covered to evaluate patients with clinical signs or symptoms suggestive of hyperparathyroidism (e.g., weakness, fatigue, bone pain, confusion, depression, nausea, vomiting, polyuria) when parathyroid disease is suspected.
3 Active Policies
A57122 — Billing and Coding: Parathormone (Parathyroid Hormone)
J09
L34018 — Parathormone (Parathyroid Hormone)
J09
REGENCE-LAB80 — Screening Laboratory Testing
Related Codes
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