CurrentBlue Cross Blue Shield - IllinoisPolicy CPCPLAB056

Gamma‑glutamyl Transferase (GGT) testing in adults

Defines reimbursement criteria for serum GGT laboratory testing for individuals 18 years or older under Blue Cross Blue Shield of Illinois laboratory management program and describes when testing is reimbursable or not reimbursable.

Policy Summary

PayerBlue Cross Blue Shield - Illinois

PolicyGamma‑glutamyl Transferase (GGT) testing in adults

Policy CodePolicy CPCPLAB056

Change TypeNo material changes — new policy effective 2025-09-25

Effective DateSep 25, 2025

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation for claims review.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

18+applies to age

once/2wmax frequency

1 codeprocedure codes listed

2025-09-25policy created

Reimbursable and Non-Reimbursable Indications

Reimbursable and non-reimbursable indications

Policy Summary

PayerBlue Cross Blue Shield - Illinois

PolicyGamma‑glutamyl Transferase (GGT) testing in adults

Policy CodePolicy CPCPLAB056

Change TypeNo material changes — new policy effective 2025-09-25

Effective DateSep 25, 2025

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation for claims review.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Policy applies to individuals 18 years of age or older; criteria do not apply to individuals under 18.

Testing reimbursable no more than once every two weeks when meeting listed clinical indications.

ONE of the following clinical indications

Elevated alkaline phosphatase activity.
At least one condition to assess for liver injury, function, or disease: chronic alcohol use; long-term drug therapy known to have potential for causing liver toxicity; exposure to hepatotoxins; viral hepatitis, amoebiasis, tuberculosis, psittacosis, or similar infections that may cause hepatic injury; primary or secondary malignant neoplasms of the digestive system; diabetes mellitus; malnutrition; disorders of iron and mineral metabolism; sarcoidosis; amyloidosis; lupus; hypertension; gastrointestinal disease; pancreatic disease; assessment of liver function subsequent to liver transplantation.

For asymptomatic individuals, serum GGT testing during a wellness visit or general exam without abnormal findings is not reimbursable.

Procedure Codes and Frequency Limits

Example procedure codesCPT

82977

Gamma-glutamyl transferase (GGT)

inv-03: Maximum reimbursable frequency — no more than once every two weeks for reimbursable indications

Maximum reimbursable frequencyNo more than once every two weeks for reimbursable indications (e.g., elevated alkaline phosphatase or other listed clinical indications).

Applicable age groupPolicy applies to individuals 18 years of age or older; criteria do not apply to individuals under 18.

Context for useReimbursement limited to when clinical indications in the policy are met (e.g., to assess liver injury/function/disease or elevated alkaline phosphatase).

Non-reimbursable circumstanceNot reimbursable for asymptomatic individuals during wellness visits or general exams without abnormal findings.

Documentation and Claims Review Requirements

Documentation Required

Documentation and claims review — submit accurate documentation and respond to requests

Providers must submit accurate documentation of services performed and submit claims using valid, industry-standard code sets; claims are subject to claim review and may be audited, and upon request providers must furnish additional documentation.

Submit claims using valid code combinations from HIPAA‑approved code sets (e.g., CPT, HCPCS, ICD‑10).
Code claims appropriately per industry standard coding guidelines (Uniform Billing, AMA CPT guidance, NCCI, CMS manuals, etc.).
Claims are subject to code edit protocols and review against benefit coverage, provider contracts, medical policies, and coding software logic.
If requested, provide additional documentation to support the services billed.

Plan Documents and Governing Order

inv-05: Plan documents and governing authority

Definition of plan documentsPlan documents include Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents.

Governing order of documentsIf a conflict exists between this Clinical Payment and Coding Policy and a plan document, the plan document governs; if a conflict exists with a provider contract, the provider contract governs.

Scope and interpretationThe Plan has implemented lab management reimbursement criteria; not all requirements apply to every product—providers should review plan documents for coverage specifics.