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Hair Analysis
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Governs coverage and clinical utility of hair analysis tests (chemical elemental analysis, hair cortisol, ethyl glucuronide, microscopic trichogram) for Aetna members and providers ordering or billing for hair testing.
No material clinical or coverage changes in this revision.
Coverage Criteria
inv-01: Experimental and Investigational — The following are considered experimental and investigational (not all-inclusive) because effectiveness has not been established:
The following are considered experimental and investigational (not an all-inclusive list) because effectiveness has not been established:
From policy: Experimental and Investigational list
inv-02: Medically Necessary: Microscopic Hair Evaluation (Trichogram) — Microscopic hair evaluation may be medically necessary when used as part of evaluation for hair disorders:
Microscopic hair evaluation may be medically necessary when used as part of evaluation for hair disorders:
CPT 96902 may be covered when selection criteria are met
Chemical hair analysis (testing hair for multiple chemical elements or metals) is considered experimental and investigational because effectiveness has not been established, except when used for diagnosis of suspected chronic arsenic poisoning. CPT and HCPCS coding in the policy distinguishes arsenic testing (e.g., CPT 82175) from multi-element panels; use of HCPCS P2031 (hair analysis excluding arsenic) is listed as not covered for the indications in this bulletin. Coverage for arsenic-related testing requires that the clinical selection criteria and appropriate ICD-10 diagnosis (for example, Z13.88 for screening for disorder due to exposure contaminants) be met.
Historical Medicare guidance has previously stated that hair analysis is not covered; the Medicare Coverage Issues Manual included the entry "Hair analysis -- not covered" (see §50-24), which is cited among the references supporting limited coverage of many hair element analyses.
Portions of the source document linked to external resources and site‑leaving notices; those fragments do not provide additional coverage exclusions or detailed medical necessity criteria beyond the policy statements contained in the bulletin.
Covered Indications
inv-29: Diagnosis of suspected chronic arsenic poisoning (hair/nail arsenic testing may be used) — Policy permits arsenic testing; hair arsenic useful in epidemiologic exposure assessment but limited for individuals.
Chemical hair analysis is generally considered experimental and investigational except as noted for arsenic testing:
Policy permits arsenic testing (CPT 82175); hair arsenic useful in population exposure assessment but limited for individuals
inv-30: Microscopic evaluation (trichogram) in work-up of alopecia or abnormal hair growth — CPT 96902 may be covered when selection criteria are met.
Microscopic hair evaluation (trichogram) coding and coverage note:
Match CPT 96902 to appropriate ICD-10 diagnosis codes (e.g., L65.0-L65.9)
inv-31: Research or investigational assessment of associations between hair biomarkers and neurodevelopmental or psychiatric conditions — Multiple studies cited evaluate associations but report heterogeneous and preliminary findings; authors call for further research and standardized methods.
Research or investigational uses — covered only in research contexts; evidence is preliminary and heterogeneous:
Multiple systematic reviews and primary studies cited; authors call for further research and standardization
inv-32: No test-specific covered indications provided in these fragments.
No additional test-specific covered indications are provided in the available document fragments.
Refer to full policy for any additional indications
Not Covered
Chemical hair analysis for purposes other than diagnosis of suspected chronic arsenic poisoning is not covered. This includes multi‑element commercial hair panels and other non‑arsenic elemental testing when used for diagnosing mineral deficiencies, metabolic disorders, allergy, autism, or similar indications. The policy identifies HCPCS P2031 (hair analysis excluding arsenic) as not covered for the indications listed in the bulletin.
Historical Medicare guidance and cited literature support a restrictive coverage stance: Medicare documentation has listed hair analysis as not covered, and multiple references in the policy note limited clinical utility and methodological concerns for many hair element analyses, supporting the decision to not cover non‑arsenic chemical hair testing.
The provided fragments do not enumerate additional explicit exclusions or list individual tests beyond the general not‑covered statement for non‑arsenic chemical hair analysis; some sections only contained external links or site‑leaving notices rather than test‑specific exclusion lists.
Coding and Billing
| 82175 | Arsenic |
| 83015 | Heavy metal (eg, arsenic, barium, beryllium, bismuth, antimony, mercury); qualitative, any number of analytes |
| P2031 | Hair analysis (excluding arsenic) |
| 96902 | Microscopic examination of hairs plucked or clipped by the examiner (excluding hair collected by the patient) to determine telogen and anagen counts, or structural hair shaft abnormality |
| Z13.88 | Encounter for screening for disorder due to exposure contaminants [suspected chronic arsenic poisoning] |
| T57.0X1A | Toxic effect of arsenic and its compounds (example range listed) |
| L65.0 | Other nonscarring hair loss [abnormal alopecia] (example range listed) |
Provider Actions & Billing Guidance
Coverage depends on meeting policy selection criteria
Coverage for the listed CPT/HCPCS procedure codes is contingent on meeting the policy's clinical selection criteria — e.g., hair/nail arsenic testing (CPT 82175) may be permitted for suspected chronic arsenic poisoning, whereas chemical multi‑element hair analysis is considered experimental/investigational and not covered except for arsenic. Ensure the ordered test and diagnosis match the policy's covered indications before billing.
- Arsenic testing CPT 82175 may be covered when selection criteria for suspected chronic arsenic poisoning are met (see ICD-10 Z13.88).
- Chemical hair analysis is experimental/investigational except for diagnosis of suspected chronic arsenic poisoning and HCPCS P2031 is listed as not covered for indications in the CPB.
No prior authorization requirements specified in policy history
Policy history and review dates are provided in the document, but no explicit prior authorization codes, procedures, or authorization prerequisites are specified in these sections.
- Last review: 05/05/2023; Effective date: 10/13/1998; Next review: 03/14/2024.
- No prior authorization requirements are listed in the fragments provided.
Prior authorization not specified in extracted sections
No prior authorization requirements or authorization codes are specified in the provided document fragments for hair analysis testing.
- The Additional Information and linked resources do not define prior authorization rules for these tests.
No additional provider actions specified in these fragments
No specific provider action requirements (e.g., ordering privileges or pre-test steps) are specified in the extracted fragments.
- Ordering and denial-trigger instructions are not present in these sections.
Step therapy: none specified
No step therapy requirements are specified in the provided policy fragments for hair analysis testing.
- The policy states indications and investigational exclusions but does not impose stepwise therapy or prior step requirements.
No provider actions specified
No additional provider actions are specified in these fragments.
Align CPT/HCPCS and ICD-10 with policy selection criteria
Ensure CPT/HCPCS procedure codes billed (for example, CPT 82175 for arsenic, CPT 83015 for heavy metal panels, and CPT 96902 for trichogram) and the ICD-10 diagnosis codes correspond precisely to the policy’s selection criteria for coverage to be considered.
- CPT 82175 — Arsenic: covered when selection criteria for suspected chronic arsenic poisoning are met.
- CPT 83015 — heavy metal qualitative panels are referenced in coding but chemical hair analysis is investigational except for arsenic.
- CPT 96902 — microscopic hair evaluation may be medically necessary when selection criteria for alopecia/work-up are met.
Document hair sample collection and analysis protocols
Document the hair sample collection and laboratory analysis details in the medical record: include collection method, hair segment length, storage conditions, and the analytical method used, because studies cited call for standardized methods for collection, storage, and analysis.
- Record hair sample length/segment used, collection technique, storage conditions, and analytical methodology in the chart or lab requisition.
- Standardized protocols are recommended by the literature to improve validity of hair cortisol and related assays.
External links provided; no explicit documentation checklist in fragments
The extracted fragments only include links to external resources and do not provide explicit, test‑specific provider documentation requirements; rely on the policy’s coding and selection criteria and document clinical indication and test-specific collection/analysis details as appropriate.
- Additional links (glossary, FAQs, etc.) are provided but do not replace required clinical documentation of indication and collection/analysis details.
HCPCS P2031 is listed as not covered
Do not bill or expect coverage for HCPCS P2031 (hair analysis excluding arsenic) for the indications listed in this CPB — P2031 is explicitly listed as not covered for indications in the policy.
- HCPCS P2031 — Hair analysis (excluding arsenic) is listed as not covered for indications in the Clinical Policy Bulletin.
Potential denial precedent from Medicare guidance
Be aware that historical Medicare guidance has listed hair analysis as 'not covered' (Medicare Coverage Issues Manual §50‑24), which may be used as precedent in denial decisions for non‑covered hair analysis indications.
- Medicare Coverage Issues Manual previously stated 'Hair analysis -- not covered' (§50-24), cited in the policy references.
No explicit denial triggers or preauthorization instructions in fragments
The extracted document fragments do not list specific denial triggers or prior authorization instructions; follow the policy selection criteria and coding alignment to avoid denials.
- No explicit denial triggers or preauthorization rules appear in these fragments; coverage risk arises if tests/diagnoses do not match the policy’s selection criteria.
Ordering Requirements
No ordering-provider restrictions specified
No specific ordering-provider restrictions are stated in these fragments; coverage is tied to meeting ICD-10/clinical selection criteria rather than explicit clinician ordering limits.
- Coverage depends on matching ICD-10/clinical selection criteria rather than on who orders the test.
No clinician-specific ordering requirements specified
The document fragments do not specify which clinicians may order hair testing; many cited studies emphasize research contexts and the need for standardized protocols rather than ordering clinician restrictions.
No ordering requirements in provided sections
These fragments do not include any explicit statements about who may order the tests; no ordering requirements are specified.
Definitions
Background
Hair analysis has been proposed as an aid in diagnosing mineral or protein deficiencies, mineral toxicity, chronic stress (measured by hair cortisol), alcohol use (hair ethyl glucuronide, HEtG), and other biomarkers, as well as for research into associations with neurodevelopmental and psychiatric conditions. However, evidence is mixed and methods are not standardized; accordingly, most chemical hair analyses remain investigational except for arsenic testing, while microscopic hair evaluation (trichogram) may be medically necessary in the work‑up of alopecia.
Frequency Limits
Revision History
Policy last reviewed on 05/05/2023; document lists this as the most recent review date.
Policy originally became effective on 10/13/1998.
Next scheduled policy review date is 03/14/2024.
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