84378
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
- The patient's medical record must include the ordering provider's assessment as it relates to the patient's complaint for that visit.
- Include relevant medical history in the medical record that supports the need for GlycoMark® testing.
- Document results of pertinent tests and procedures; for diagnostic tests report the result if known, otherwise report the symptoms prompting the performance of the test.
- All services ordered or rendered to Medicare beneficiaries must be signed and include a signed and dated office visit record or operative report.
Key Coverage Criteria
- Bill GlycoMark® testing using CPT code 84378 or, if appropriate, CPT 84999.
- No clinical coverage indications are specified in this billing/coding guidance; clinical coverage criteria for GlycoMark® testing are defined in Local Coverage Determination L36761.
- GlycoMark testing for assessment of glycemic control (use when local coverage determination authorizes GlycoMark testing).
- Persons with discrepant celiac-specific serology and histology;
- Serological testing of IgA anti-human tissue transglutaminase (TTG) antibodies, IgG and IgA deamidated gliadin antibodies (DGP), and IgA anti-endomysial antibodies (EMA) for any of the following indications:
- As a preliminary diagnostic test for persons with symptoms suggestive of celiac disease;
9 Active Policies
A57238 — Billing and Coding: GlycoMark Testing for Glycemic Control
AETNA-CPB-0561 — Celiac Disease Laboratory Testing
A56465 — Billing and Coding: GlycoMark Testing for Glycemic Control
A56872 — Billing and Coding: GlycoMark Testing for Glycemic Control
A57237 — Billing and Coding: GlycoMark Testing for Glycemic Control
Related Codes
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