Thyroid Hormones and Insulin Testing in Pediatrics

This policy covers laboratory testing of pediatric thyroid hormones (eg, TSH, T4) and plasma insulin, permitting testing when clinically indicated such as evaluation of suspected thyroid dysfunction or endocrine assessment in children with obesity who demonstrate attenuated stature/height velocity relative to genetic/pubertal expectations, with obesity classified by CDC BMI percentiles. Routine thyroid or insulin testing in otherwise healthy children (ages 1–18), including those who are obese, is considered not medically necessary; isolated TSH/total T4 elevations in overweight/obese youths should be interpreted cautiously, insulin assays lack standardized cutoffs and are regarded as research tools, and specific CPT/ICD-10 code pairings listed are not covered—providers must follow current coding guidance prior to claim submission.

"Quantification of thyroid hormone levels (e."