CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLABOSS

Parathyroid Hormone, Phosphorous, Calcium and Magnesium Testing Reimbursement Policy

Defines BCBSNM laboratory management reimbursement criteria for PTH, phosphorus, calcium, and magnesium testing and explains when these tests may or may not be reimbursable for members covered by Blue Cross Blue Shield New Mexico.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyParathyroid Hormone, Phosphorous, Calcium and Magnesium Testing Reimbursement Policy

Policy CodePolicy CPCPLABOSS

Change TypeNew policy with revisions and reference updates

Effective DateJun 15, 2023

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request.

SourceLink

POLICY UPDATE CHANGES

New policy implemented with literature review and reimbursement information.

Reimbursement information revised for clarity.

References revised; some added and others removed.

1.0policy version

2023-04-12approval date

2023-06-15effective date

1document updates

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyParathyroid Hormone, Phosphorous, Calcium and Magnesium Testing Reimbursement Policy

Policy CodePolicy CPCPLABOSS

Change TypeNew policy with revisions and reference updates

Effective DateJun 15, 2023

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request.

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.

Lab test reimbursement criteria

Reimbursement criteria and non-reimbursable scenarios for serum intact PTH, phosphorus, calcium, and magnesium testing.

ANY of the following

To assess for possible hyperparathyroidism in individuals with hypercalcemia.
As part of annual testing of an individual previously diagnosed with hyperparathyroidism.
To assess post-operative results of parathyroid surgery.
As part of an assessment of chronic kidney disease (CKD).
As part of an assessment of osteoporosis.
As part of a diagnosis and/or assessment of cancer or cancer therapy.

ANY of the following

Initial assessment and diagnosis of the disorders listed in Note 1 (e.g., hypoparathyroidism, pseudohypoparathyroidism and related disorders).
See Note 1: Conditions listed include hypoparathyroidism, pseudohypoparathyroidism, and related disorders (Mantovani et al., 2018).
To monitor disease and/or therapy.

Serum intact PTH testing to screen for asymptomatic hyperparathyroidism is not reimbursable.

ALL of the following

Serum phosphorus or phosphate testing.
Serum, blood, or fecal magnesium testing.
Urine phosphorus or phosphate testing.
Serum parathyroid hormone testing.
Serum total calcium, serum ionized calcium, or urine calcium testing.

Testing serum for truncated parathyroid hormone metabolites (e.g., amino-terminal and carboxy-terminal fragments) is not reimbursable.

Conditions referenced for consideration in coverage decisions include: Hypoparathyroidism; Pseudohypoparathyroidism Type 1A (PHP1A); Pseudohypoparathyroidism Type 1B (PHP1B); Pseudopseudohypoparathyroidism (PPHP); Progressive Osseous Heteroplasia (POH); and Acrodysostosis (ACRDYS2).

These conditions are listed in policy Note 1 as related disorders for which PTH testing may be indicated.

Procedure Codes and Coding Standards

Procedure codes guidancemixed

Document lists procedure codes are not exhaustive; inclusion does not guarantee coverage.

Coding standards

Coding standardsClaims must be coded using HIPAA‑approved code sets and industry standard coding guidelines, including but not limited to CPT, HCPCS, ICD‑10 CM/PCS, NDC, UB, DRG, and CMS NCCI rules.

Valid code combinationsProviders are expected to submit claims using valid code combinations from HIPAA‑approved code sets and follow applicable code edit protocols and CCI table edits.

Claims subject to reviewClaims are subject to claim review and coding software logic, and may be reviewed against benefit coverage terms, provider contracts, medical and coding policies.

Provider documentationProviders are responsible for submission of accurate documentation and may be requested to provide additional documentation upon review.

Applicable coding resourcesIndustry resources referenced include the AMA CPT guidance, UB Editor, CMS NCCI Policy Manual, and other CMS guidelines.

Documentation and Claims Review

Documentation Required

Documentation, coding, and claims review — submit accurate documentation and provide additional records upon request

Providers are responsible for submitting accurate documentation of services performed and must code claims using valid HIPAA‑approved code sets and industry standard coding guidelines. Claims are subject to code edit protocols and review against plan documents, provider contract language, medical policies, clinical payment and coding policies, and coding software logic; upon request, providers must submit additional documentation to support the claim.

Submit claims using valid code combinations from HIPAA‑approved code sets (CPT, HCPCS, ICD-10, NDC, UB, DRG, CMS NCCI, etc.).
Claims are subject to code edit protocols and claim review including plan documents and provider contract language.
If requested, provide additional documentation to support services billed.

Definitions and Test Details

Plan documents

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

Governing authorityIf a conflict arises between this Clinical Payment and Coding Policy and any plan document under which a member is entitled to Covered Services, the plan document will govern.

Provider contract precedenceIf a conflict arises between this CPCP and any provider contract, the provider contract will govern.

BCBSNM discretionBCBSNM may use reasonable discretion interpreting and applying this policy and has final discretionary authority to the extent provided under applicable plan documents.

Serum intact PTH testing indications

Reimbursable indicationsSerum intact PTH testing may be reimbursable to assess possible hyperparathyroidism in individuals with hypercalcemia, as part of annual testing for previously diagnosed hyperparathyroidism, to assess post‑operative results of parathyroid surgery, as part of assessment of chronic kidney disease (CKD), as part of assessment of osteoporosis, and as part of diagnosis/assessment of cancer or cancer therapy.

Hypoparathyroidism evaluationFor suspected hypoparathyroidism, pseudohypoparathyroidism, or related disorders, serum intact PTH testing may be reimbursable for initial assessment/diagnosis and to monitor disease or therapy.

Not reimbursable — screeningSerum intact PTH testing to screen for asymptomatic hyperparathyroidism is not reimbursable.

Not reimbursable — wellnessWhen individuals present for wellness or a general exam without abnormal findings, serum PTH, phosphorus, calcium, and magnesium testing (serum, blood, fecal, or urine where listed) are not reimbursable.

Not reimbursable — specialized assaysTesting serum for truncated parathyroid hormone metabolites (e.g., amino‑terminal and carboxy‑terminal fragments) is not reimbursable.

OpenPayer

Parathyroid Hormone, Phosphorous, Calcium and Magnesium Testing Reimbursement Policy

Reimbursement Criteria

Procedure Codes and Coding Standards

Documentation and Claims Review

Definitions and Test Details