ModifiedBlue Cross Blue Shield - New MexicoPolicy CPCPLAB056

Gamma-glutamyl Transferase Testing in Adults

Reimbursement and coding criteria from Blue Cross Blue Shield of New Mexico for serum GGT testing in individuals 18 years and older, including when testing is reimbursable and when it is not.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyGamma-glutamyl Transferase Testing in Adults

Policy CodePolicy CPCPLAB056

Change TypeMaterial reimbursement and age-clarifying edits

Effective DateJan 15, 2025

Next Review Date

Key ActionSubmit accurate documentation and supporting records upon request to support reimbursement for serum GGT testing in adults.

SourceLink

POLICY UPDATE CHANGES

Note clarifying the criteria in the policy applies only to individuals ages 18 years of age or older.

References revised and literature review updated.

Title changed from 'Gamma-glutamyl Transferase'.

Drug ingestion removed from a prior criterion (2a); frequency added to items #1 and #2; Note 1 removed.

Policy originally created as new policy on 2022-11-01.

18+age group covered

once/2wkmax frequency

82977procedure code listed

1.0

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Coverage Criteria

Reimbursable and non-reimbursable criteria

Reimbursable indications and limits for serum GGT testing in individuals 18 years or older.

Applies to individuals 18 years of age or older; criteria below do not apply to individuals less than 18 years of age.

Reimbursable when ANY of the following are met:

For individuals with elevated alkaline phosphatase activity, serum GGT testing reimbursable no more than once every two weeks.
To assess for liver injury, function, and/or disease, serum GGT testing reimbursable no more than once every two weeks for individuals with at least one of the following conditions: 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; diabetes mellitus; malnutrition; disorders of iron and mineral metabolism; amyloidosis; sarcoidosis; lupus; hypertension; gastrointestinal disease; pancreatic disease; and as part of liver function assessment subsequent to liver transplantation.

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

Reimbursement criteria updates

Reimbursement criteria was updated; age limitation specified.

Policy update clarifies that the reimbursement criteria apply only to individuals 18 years of age or older.

Policy history: updates include removal of drug ingestion from a prior criterion, addition of a maximum frequency (no more than once every two weeks) to reimbursable items, and other wording changes for clarity as noted in the Policy Update History.

Coding and Frequency

Listed procedure codesCPT

82977

Gamma-Glutamyl Transferase (GGT) test

No specific CPT/HCPCS/ICD codes listed in this partmixed

No codes listed

Maximum frequency — inv-05: Maximum frequency

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

Frequency applies to assessment of liver injury/functionSerum GGT testing for assessing liver injury, function, and/or disease is reimbursable no more than once every two weeks for eligible individuals

Not for routine/asymptomatic screeningTesting frequency limit does not permit routine or wellness‑visit GGT testing in asymptomatic individuals without abnormal findings

Age applicability — inv-06: Age applicability

Age applicabilityPolicy applies only to individuals 18 years of age or older

Provider Actions and Billing

Documentation Required

Documentation and claims review — Providers must maintain accurate records

Providers are responsible for submission of accurate documentation of services performed. Providers are expected to submit claims for services rendered using valid code combinations from HIPAA-approved code sets and to code appropriately according to industry-standard coding guidelines (including, but not limited to, UB Editor, AMA CPT, CPT Assistant, HCPCS, ICD-10-CM/PCS, NDCs, DRG guidelines, CMS NCCI Policy Manual and edits). Claims are subject to code edit protocols and claim review against benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic. Upon request, providers are urged to submit any additional documentation to support medical necessity and coding. Failure to provide complete and accurate documentation may result in claim denial or retrospective adjustments.

Include operative notes, diagnostic test results, and medical records when requested.
Submit claims using valid CPT/HCPCS and ICD-10 codes consistent with documentation.
Be prepared to supply additional records upon request for medical necessity review or audit.

Definitions, References, and Miscellany

Plan documents — inv-09

Plan documents govern in conflictsIf a conflict arises between a CPCP and any plan document under which a member is entitled to Covered Services, the plan document will govern

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

Provider contracts govern in provider conflictsIf a conflict arises between a CPCP and any provider contract pursuant to which a provider participates, the provider contract will govern

References — inv-10

Clinical and research referencesMultiple peer‑reviewed studies and reviews on GGT and liver function, disease associations, and biomarker roles are cited (see listed references)

Selected guideline reference

Billing Rule

Reimbursement updates and age applicability

Reimbursement Information was updated to clarify that the policy criteria apply only to individuals 18 years of age and older. Providers should confirm member age and plan applicability when submitting claims; reimbursement and coverage determinations that reference this policy are limited to adults (>= 18 years). Other reimbursement criterion changes were made in prior revisions — providers should review the policy history and applicable plan documents for any frequency or coverage edits that may affect billing.

Criteria in this policy apply only to individuals 18 years of age or older (adult members).
Verify member eligibility and age before billing; pediatric cases may not meet the policy's reimbursement criteria.
Review prior policy updates for changes to frequency limits or other reimbursement details that could affect claims processing.