ModifiedBlue Cross Blue Shield - New MexicoPolicy CPCPLAB055

Parathyroid Hormone, Phosphorous, Calcium and Magnesium Testing

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Defines reimbursement criteria and coding guidance for serum and urine testing of parathyroid hormone (PTH), phosphorus, calcium, and magnesium for members covered by Blue Cross and Blue Shield of New Mexico and applies to providers submitting claims to BCBSNM.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyParathyroid Hormone, Phosphorous, Calcium and Magnesium Testing

Policy CodePolicy CPCPLAB055

Change TypeConsolidation and addition of Note 2

Effective DateAug 8, 2025

Last ReviewApr 28, 2025

Next Review Date

Key ActionSubmit accurate documentation and be prepared to provide additional documentation upon request for claims subject to review.

SourceLink

POLICY UPDATE CHANGES

Combined #1 and #2 into a single criterion describing appropriate testing indications for PTH and enumerated numerous specific clinical situations and frequencies of testing (including CKD staging and age-specific intervals for pseudohypoparathyroidism).

Added Note 2 describing the conditions pseudohypoparathyroidism.

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ModifiedBlue Cross Blue Shield - New MexicoPolicy CPCPLAB055

Parathyroid Hormone, Phosphorous, Calcium and Magnesium Testing

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Sign up for Blue Cross Blue Shield - New Mexico Policy CPCPLAB055 alerts

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Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyParathyroid Hormone, Phosphorous, Calcium and Magnesium Testing

Policy CodePolicy CPCPLAB055

Change TypeConsolidation and addition of Note 2

Effective DateAug 8, 2025

Last ReviewApr 28, 2025

Next Review Date

Key ActionSubmit accurate documentation and be prepared to provide additional documentation upon request for claims subject to review.

SourceLink

POLICY UPDATE CHANGES

Added Note 2 describing the conditions pseudohypoparathyroidism.

6Reimbursable situations

12mAnnual CKD Grade 3 interval

3mCKD Grade 4-5 interval

Coverage Criteria for PTH and Related Tests

Reimbursement criteria

Situations when serum intact PTH testing may be reimbursed and explicit non-reimbursable tests/frequencies.

ANY of the following

For individuals with abnormal calcium levels.
One-time testing for the diagnosis of hypoparathyroidism for individuals with signs of hypoparathyroidism (see Note 1).
For individuals with osteoporosis or low bone mass.
For individuals who have undergone parathyroidectomy.
One test every year for individuals diagnosed with hyperparathyroidism who have not undergone parathyroidectomy.
ALL of the following
- Grade 3 CKD: one test every twelve months.
- Grade 4 or Grade 5 CKD: one test every three months.
One-time testing for individuals with multiple endocrine neoplasia type 2A (MEN2A) or familial medullary thyroid carcinoma.
For individuals with pseudohypoparathyroidism or related disorders: children (<18 years): one test every three months; adults (≥18 years): one test every year.

PTH testing coverage criteria and frequencies

Serum intact parathyroid hormone (PTH) testing MEETS COVERAGE CRITERIA in any of the following situations:

ANY of the following

Abnormal calcium levels.
One-time testing for diagnosis of hypoparathyroidism in individuals with signs of hypoparathyroidism.
Individuals with osteoporosis or low bone mass.
Individuals who have undergone parathyroidectomy.
Individuals diagnosed with hyperparathyroidism who have not undergone parathyroidectomy: one test every year.
ALL of the following

Procedure Codes and Testing Frequencies

Procedure codes referencedCPT

82310
82330
82340
83735
83970
84100
84105

Not specified in this excerptCPT

No codes listed

inv-05: PTH testing frequency for CKD grade 3

CKD Grade 3 PTH testing frequencyOne test every 12 months

ContextApplies to individuals with chronic kidney disease Grade 3 per PTH coverage criteria

Policy sourceReimbursement Information sections specifying CKD frequencies

inv-06: PTH testing frequency for CKD grade 4-5

CKD Grade 4-5 PTH testing frequencyOne test every 3 months

ContextApplies to individuals with chronic kidney disease Grade 4 or Grade 5 per PTH coverage criteria

Provider Responsibilities and Operational Notes

Documentation Required

Documentation and claims review

Providers are responsible for submission of accurate documentation of services performed and are urged to submit additional documentation upon request; claims are subject to review against benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and code edit protocols.

Note

Coverage criteria and testing frequency (no PA/step therapy specified)

Serum intact PTH testing meets coverage criteria in specific clinical situations and at defined frequencies; no prior authorization or step therapy is specified in this segment.

Reimbursable indications include: abnormal calcium, one‑time testing for hypoparathyroidism (signs present), osteoporosis/low bone mass, post‑parathyroidectomy, one test yearly for untreated hyperparathyroidism, one‑time testing for MEN2A/familial medullary thyroid carcinoma.
Frequency rules: CKD Grade 3 — one test every 12 months; CKD Grade 4–5 — one test every 3 months; pseudohypoparathyroidism — <18 years: every 3 months; ≥18 years: every year.

Clinical Definitions and Related Disorders

inv-13: Signs of hypoparathyroidism

HypocalcemiaListed as a sign of hypoparathyroidism

Elevated serum phosphorusListed as a sign of hypoparathyroidism

Low calcitriolListed as a sign of hypoparathyroidism

HypercalciuriaListed as a sign of hypoparathyroidism

Abnormal magnesiumListed as a sign of hypoparathyroidism

inv-14: Pseudohypoparathyroidism and related disorders

PHP1APseudohypoparathyroidism Type 1A (maternal GNAS loss-of-function)

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyParathyroid Hormone, Phosphorous, Calcium and Magnesium Testing

Policy CodePolicy CPCPLAB055

Change TypeConsolidation and addition of Note 2

Effective DateAug 8, 2025

Last ReviewApr 28, 2025

Next Review Date

Key ActionSubmit accurate documentation and be prepared to provide additional documentation upon request for claims subject to review.

SourceLink

On This Page

Grade 3: one test every 12 months.

Grade 4 or Grade 5: one test every 3 months.

One-time testing for individuals with multiple endocrine neoplasia type 2A (MEN2A) or familial medullary thyroid carcinoma.

ALL of the following

Individuals <18 years: one test every 3 months.
Individuals ≥18 years: one test every year.

Reimbursement Information sections specifying CKD frequencies

inv-07: PTH testing frequency for hyperparathyroidism (if no parathyroidectomy)

Hyperparathyroidism (no parathyroidectomy) frequencyOne test every year

ContextApplies to individuals diagnosed with hyperparathyroidism who have not undergone parathyroidectomy

Policy sourceReimbursement Information: one test every year for individuals diagnosed with hyperparathyroidism

inv-08: PTH testing frequency for pseudohypoparathyroidism patients <18

Pseudohypoparathyroidism (<18 years) frequencyOne test every 3 months

ContextApplies to individuals under 18 with pseudohypoparathyroidism or related disorders per Note 2

Policy sourceReimbursement Information: frequency for pseudohypoparathyroidism or related disorders

inv-09: PTH testing frequency for pseudohypoparathyroidism patients ≥18

Pseudohypoparathyroidism (≥18 years) frequencyOne test every year

ContextApplies to individuals 18 years or older with pseudohypoparathyroidism or related disorders per Note 2

Policy sourceReimbursement Information: frequency for pseudohypoparathyroidism or related disorders

inv-10: CKD testing frequency thresholds

CKD testing frequency — Grade 3Every 12 months

CKD testing frequency — Grade 4-5Every 3 months

Policy sourceReimbursement Information consolidating CKD frequency thresholds

PHP1BPseudohypoparathyroidism Type 1B (GNAS methylation defect)

PPHPPseudopseudohypoparathyroidism (paternal GNAS loss-of-function)

POHProgressive Osseous Heteroplasia (paternal GNAS loss-of-function)

AcrodysostosisAcrodysostosis (ACRDYS1 due to PRKAR1A; ACRDYS2 due to PDE4D)

inv-15: pseudohypoparathyroidism

Note 2 descriptionNote 2 describes the conditions included in pseudohypoparathyroidism (exact Note 2 text referenced in policy update)

ContextAdded to the consolidated PTH coverage criterion as part of the 04/28/2025 update

SourcePolicy Update History entry noting addition of Note 2