ModifiedBlue Cross Blue Shield - New MexicoPolicy CPCPLAB055

Parathyroid Hormone, Phosphorous, Calcium and Magnesium Testing

Defines BCBSNM reimbursement criteria and frequency limits for serum parathyroid hormone (PTH) and related calcium, phosphorus and magnesium tests; applies to providers submitting claims to BCBSNM for covered members. Some requirements vary by product—providers should check plan documents for specific applicability.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyParathyroid Hormone, Phosphorous, Calcium and Magnesium Testing

Policy CodePolicy CPCPLAB055

Change TypeConsolidation and frequency rule additions

Effective DateAug 8, 2025

Next Review Date

Key ActionSubmit accurate documentation and use valid HIPAA-approved code sets when filing claims; claims are subject to review and applicable plan documents govern coverage.

SourceLink

POLICY UPDATE CHANGES

Combined #1 and #2 into a single criterion to describe all appropriate testing indications for PTH and specified detailed indications and frequencies for multiple clinical scenarios including CKD stages, post-parathyroidectomy, osteoporosis, MEN2A, pseudohypoparathyroidism, and others.

7Example procedure codes

6Reimbursable situations

2CKD frequency rules

5Signs listed

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.

Coverage criteria for PTH and related mineral testing

Covered Indications and Frequencies

Serum intact parathyroid hormone (PTH) testing MEETS COVERAGE CRITERIA in any of the following situations. Frequency limits apply where specified.

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 signs of hypoparathyroidism (hypocalcemia, elevated serum phosphorous, low calcitriol, hypercalciuria, abnormal magnesium).
For individuals with osteoporosis or low bone mass.
For individuals who have undergone parathyroidectomy.
Hyperparathyroidism monitoring
- For individuals diagnosed with hyperparathyroidism who have not undergone parathyroidectomy.
- Frequency: One test every year.
  Annual testing applies only to individuals diagnosed with hyperparathyroidism who have not undergone parathyroidectomy.
Chronic kidney disease (CKD)
- For individuals with Grade 3 CKD.
- Frequency: One test every twelve months.
  Applies to Grade 3 CKD only.
- For individuals with Grade 4 or Grade 5 CKD.
- Frequency: One test every three months.
  Applies to Grade 4 or Grade 5 CKD only.
One-time testing for individuals with multiple endocrine neoplasia type 2A (MEN2A) or familial medullary thyroid carcinoma.
Pseudohypoparathyroidism and related disorders
- For individuals who are less than 18 years of age.
- Frequency: One test every three months.
  Applies to individuals <18 years with pseudohypoparathyroidism or related disorders (see Note 2 for included conditions).
- For individuals who are 18 years of age or older.
- Frequency: One test every year.
  Applies to individuals ≥18 years with pseudohypoparathyroidism or related disorders (see Note 2).

Procedure codes and frequency rules

Example laboratory procedure codes referencedCPT

82310	Calcium; total
82330	Calcium; ionized
82340	Phosphorus; inorganic (phosphate)
83735	Magnesium; serum
83970	Parathyroid hormone (PTH)
84100	Parathyroid hormone; other (may map to specific assays)
84105	Parathyroid hormone; intact PTH

PTH testing frequency — CKD Grade 3

CKD Grade 3 frequencyOne test every twelve months

Required evidenceDocumentation of CKD Grade 3

Coverage notePTH testing for CKD Grade 3 meets coverage criteria when CKD stage documented

PTH testing frequency — CKD Grade 4 or 5

CKD Grade 4 or 5 frequencyOne test every three months

Required evidenceDocumentation of CKD Grade 4 or Grade 5

Coverage note

Documentation, claims, and coverage summary

Documentation Required

Documentation and claim submission requirements

Providers must submit accurate documentation of services performed and submit claims using valid HIPAA‑approved code sets. Claims are subject to code edit protocols and claim review; upon request providers should submit any additional documentation. If a conflict exists, applicable plan documents or provider contracts govern.

Submit claims using valid code combinations from HIPAA‑approved code sets (CPT, HCPCS, ICD‑10, NDC, DRG guidance, CMS NCCI, etc.).
Claims are subject to code edit protocols and review against benefit coverage, provider contracts, medical policies, and coding software logic.
Provide additional documentation upon request to support medical necessity or coding.

Note

Coverage summary and required testing frequencies for serum intact PTH

Serum intact parathyroid hormone (PTH) testing meets coverage criteria in specific clinical situations; where frequencies are specified, providers must follow the stated testing intervals.

Clinical definitions and example conditions

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

Pseudohypoparathyroidism and related disorders (examples)

Pseudohypoparathyroidism examplesIncludes PHP1A, PHP1B, PPHP, Progressive Osseous Heteroplasia (POH), Acrodysostosis types ACRDYS1 and ACRDYS2.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyParathyroid Hormone, Phosphorous, Calcium and Magnesium Testing

Policy CodePolicy CPCPLAB055

Change TypeConsolidation and frequency rule additions

Effective DateAug 8, 2025

Next Review Date

Key ActionSubmit accurate documentation and use valid HIPAA-approved code sets when filing claims; claims are subject to review and applicable plan documents govern coverage.

SourceLink

On This Page

PTH testing for CKD Grade 4–5 meets coverage criteria at specified quarterly intervals

PTH testing frequency — Hyperparathyroidism without parathyroidectomy

Hyperparathyroidism (no parathyroidectomy)One test every year

Required evidenceDiagnosis of hyperparathyroidism without parathyroidectomy

Coverage noteAnnual PTH testing allowed for individuals diagnosed with hyperparathyroidism who have not undergone parathyroidectomy

PTH testing frequency — Pseudohypoparathyroidism (age <18)

Pseudohypoparathyroidism — age <18One test every three months

Required evidenceDiagnosis of pseudohypoparathyroidism or related disorder; patient age <18

Coverage noteQuarterly testing for pediatric individuals with pseudohypoparathyroidism meets coverage criteria

PTH testing frequency — Pseudohypoparathyroidism (age ≥18)

Pseudohypoparathyroidism — age ≥18One test every year

Required evidenceDiagnosis of pseudohypoparathyroidism or related disorder; patient age ≥18

Coverage noteAnnual testing for adults with pseudohypoparathyroidism meets coverage criteria

CKD testing frequency thresholds

Grade 3One test every 12 months

Grade 4 or 5One test every 3 months

Required evidenceDocumentation of CKD stage for testing frequency determination

For individuals with abnormal calcium levels — PTH testing meets coverage criteria.
One‑time testing for diagnosis of hypoparathyroidism when signs of hypoparathyroidism are present.
For individuals with osteoporosis or low bone mass — PTH testing meets coverage criteria.
For individuals post‑parathyroidectomy — PTH testing meets coverage criteria.
For hyperparathyroidism without parathyroidectomy — one test every year.
For CKD: Grade 3 — one test every 12 months; Grade 4 or 5 — one test every 3 months.
One‑time testing for MEN2A or familial medullary thyroid carcinoma.
For pseudohypoparathyroidism/related disorders: age <18 — one test every 3 months; age ≥18 — one test every year.

PHP1A causeDue to maternal loss of function mutation at the GNAS coding sequence

PHP1B causeDue to methylation defect at the GNAS coding sequence

PPHP/POH causeDue to paternal loss of function mutation at the GNAS coding sequence

pseudohypoparathyroidism — reference

Term referencedpseudohypoparathyroidism

Policy noteSee Note 2 for conditions classified as pseudohypoparathyroidism or related disorders

Coverage tie-inTesting frequencies for pseudohypoparathyroidism are specified (see pediatric vs adult rules)