National Coverage Determination
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CMS Policy Number: 190.22
Description: Thyroid function studies are used to delineate the presence or absence of hormonal abnormalities of the thyroid and pituitary glands. These abnormalities may be either primary or secondary and often but not always accompany clinically defined signs and symptoms indicative of thyroid dysfunction.
Laboratory evaluation of thyroid function has become more scientifically defined. Tests can be done with increased specificity, thereby reducing the number of tests needed to diagnose and follow treatment of most thyroid disease. Measurements of serum sensitive thyroid-stimulating hormone (TSH) levels, complemented by determination of thyroid hormone levels [free thyroxine (fT-4) or total thyroxine (T4) with Triiodothyronine (T3) uptake] are used for diagnosis and follow-up of patients with thyroid disorders. Additional tests may be necessary to evaluate certain complex diagnostic problems or on hospitalized patients, where many circumstances can skew tests results. When a test for total thyroxine (total T4 or T4 radioimmunoassay) or T3 uptake is performed, calculation of the free thyroxine index (FTI) is useful to correct for abnormal results for either total T4 or T3 uptake due to protein binding effects.
Thyroid function tests are used to define hyper function, euthyroidism, or hypofunction of thyroid disease. Thyroid testing may be reasonable and necessary to:
Distinguish between primary and secondary hypothyroidism
Confirm or rule out primary hypothyroidism
Monitor thyroid hormone levels (for example, patients with goiter, thyroid nodules, or thyroid cancer)
Monitor drug therapy in patients with primary hypothyroidism
Confirm or rule out primary hyperthyroidism
Monitor therapy in patients with hyperthyroidism
Thyroid function testing may be medically necessary in patients with disease or neoplasm of the thyroid and other endocrine glands. Thyroid function testing may also be medically necessary in patients with metabolic disorders; malnutrition; hyperlipidemia; certain types of anemia; psychosis and non-psychotic personality disorders; unexplained depression; ophthalmologic disorders; various cardiac arrhythmias; disorders of menstruation; skin conditions; myalgias; and a wide array of signs and symptoms, including alterations in consciousness; malaise; hypothermia; symptoms of the nervous and musculoskeletal system; skin and integumentary system; nutrition and metabolism; cardiovascular; and gastrointestinal system.
It may be medically necessary to do follow-up thyroid testing in patients with a history of malignant neoplasm of the endocrine system and in patients on long-term thyroid drug therapy.
Testing may be covered up to two times a year in clinically stable patients; more frequent testing may be reasonable and necessary for patients whose thyroid therapy has been altered or in whom symptoms or signs of hyperthyroidism or hypothyroidism are noted.
Documentation Requirements: When these tests are billed at a greater frequency than the norm (two per year), the ordering physician’s documentation must support the medical necessity of this frequency.
Frequency Limitations: Testing may be covered up to two times a year in clinically stable patients; more frequent testing may be reasonable and necessary for patients whose thyroid therapy has been altered or in whom symptoms or signs of hyper- or hypothyroidism are noted.
To review all requirements of this policy, please see:
CMS NCD listing by Chapter
Covered ICD-10 Codes.
.... and many more.
|A18.81||Tuberculosis of thyroid gland|
|C56.1||Malignant neoplasm of right ovary|
|C56.2||Malignant neoplasm of left ovary|
|C56.3||Malignant neoplasm of bilateral ovaries|
|C56.9||Malignant neoplasm of unspecified ovary|
|C73||Malignant neoplasm of thyroid gland|
|C75.8||Malignant neoplasm with pluriglandular involvement, unsp|
|C79.63||Secondary malignant neoplasm of bilateral ovaries|
|C79.89||Secondary malignant neoplasm of other specified sites|
|C79.9||Secondary malignant neoplasm of unspecified site|
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