CodeMap®  150 North Wacker Drive
Suite 1870
Chicago, IL 60606
847-381-5465 Phone
847-381-4606 Fax
customerservice@codemap.com
      


User Information

Create New Account

Lost Password

Username:
Password:


Quick Links

LCDs and LCAs
by Contractor

PLA Codes

Laboratory Fee Schedule

2020 (April)
2019

Physician Fee Schedule

2020
2019

OPPS Fee Schedule

2020-April
2020-January

ASC Fee Schedule

2020-April
2020-January

APC Codes

2020-April
2020-January

DRG Codes

2020
2019

ASP Drug Pricing Files

April 2020
January 2020


CMS Transmittals




Webinar: 2020 Regulatory Update: Hospital Outreach Programs Wednesday, June 17, 2020

National Coverage Determination
Procedure Code: 8XXXX
Thyroid Testing
CMS Policy Number: 190.22
Back to NCD List

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.

Indications:
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.

    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 hyperthyroidism or hypothyroidism are noted.

    Other:
    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.

    A18.81Tuberculosis of thyroid gland
    C56.1Malignant neoplasm of right ovary
    C56.2Malignant neoplasm of left ovary
    C56.9Malignant neoplasm of unspecified ovary
    C73Malignant neoplasm of thyroid gland
    C75.8Malignant neoplasm with pluriglandular involvement, unsp
    C79.89Secondary malignant neoplasm of other specified sites
    C79.9Secondary malignant neoplasm of unspecified site
    D09.3Carcinoma in situ of thyroid and other endocrine glands
    D09.8Carcinoma in situ of other specified sites
    .... and many more.


    Sorry, you need to login or register to view additional sections of this Medicare policy.

    Click here for publications catalog.
    --

    The content and format of the following files and/or webpages are copywritten and the property of Wheaton Partners, LLC - dba CodeMap®. All recipients of these files agree not to distribute, reproduce and/or use the information contained within, in any manner not expressly agreed upon by the user and Wheaton Partners, LLC - dba CodeMap®.

    All code-pairs and Medicare coverage information are compiled directly from Center for Medicare and Medicaid Services (CMS) and Medicare Contractor coverage policies. CodeMap® has made every reasonable effort to ensure the accuracy of the information contained. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. Both CMS and Medicare contractor coverage policy information may change at any time. CodeMap® makes no representation, warranty, or guarantee that this compilation of coverage policy information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.


  • CodeMap® is a Registered Trademark of Wheaton Partners, LLC.