CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLAB055

Parathyroid Hormone, Phosphorous, Calcium and Magnesium Testing

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

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyParathyroid Hormone, Phosphorous, Calcium and Magnesium Testing

Policy CodePolicy CPCPLAB055

Change TypeClarified reimbursement languagereferences revised

Effective DateJun 15, 2023

Next Review DateN/A

Key ActionProviders must submit accurate documentation and use valid HIPAA-approved code sets; claims are subject to review and additional documentation may be requested.

SourceLink

POLICY UPDATE CHANGES

Reimbursement information revised for clarity.

Document updated with literature review; references revised with some added and others removed.

7procedure codes listed

6reimbursable indications

multiplereferences cited

1policy version

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.

inv-01: Reimbursement criteria and exclusions for PTH, phosphorus, calcium and magnesium testing

Covered when the following clinical indications and exclusions apply:

ALL of the following

ANY of the following
- To assess for possible hyperparathyroidism in individuals with hypercalcemia
- To assess post-operative results of parathyroid surgery
- As part of annual testing of an individual previously diagnosed with hyperparathyroidism
- As part of an assessment of chronic kidney disease (CKD)
- As part of an assessment of osteoporosis
- As part of a diagnosis and/or an assessment of cancer or cancer therapy
ANY of the following
- In the initial assessment and diagnosis of hypoparathyroidism, pseudohypoparathyroidism, or related disorders
- To monitor disease and/or therapy for individuals with suspected hypoparathyroidism, pseudohypoparathyroidism, or related disorders
ALL of the following
- ANY of the following
  - Hypoparathyroidism
  - Pseudohypoparathyroidism Type 1A (PHP1A) - due to maternal loss of function mutation at the GNAS coding sequence
  - Pseudohypoparathyroidism Type 1B (PHP1B) - due to methylation defect at the GNAS coding sequence
  - Pseudopseudohypoparathyroidism (PPHP) - due to paternal loss of function mutation at the GNAS coding sequence
  - Progressive Osseous Heteroplasia (POH) - due to paternal loss of function mutation at the GNAS coding sequence

ALL of the following

Serum intact parathyroid (PTH) testing to screen for asymptomatic hyperparathyroidism is not reimbursable
Testing serum for truncated parathyroid hormone metabolites (e.g., amino-terminal and carboxy-terminal fragments) is not reimbursable
ALL of the following
- ANY of the following
  - Serum, blood, or fecal magnesium testing
  - Serum phosphorus or phosphate testing
  - Urine phosphorus or phosphate testing

Note 1: Conditions of hypoparathyroidism, pseudohypoparathyroidism, and related disorders are referenced as indications for testing

See Note 1 in source for conditions referenced

inv-02: Extract scope and references

Policy update history and supporting references relevant to the coverage guidance:

ALL of the following

6/15/2023: New policy — Document updated with literature review. Reimbursement information revised for clarity. References revised; some added, others removed.

ALL of the following

Pearle MS et al., 2019. Medical Management of Kidney Stones: AUA Guideline (J Urol).
Quamme GA, 1986. Renal handling of magnesium (Magnesium).
Rodriguez-Ortiz ME et al., 2014. Magnesium modulates PTH secretion (Nephrol Dial Transplant).

Procedure Codes and Coding Notes

Listed laboratory procedure codesCPT

82310
82330
82340
83735
83970
84100
84105

No codes present in this extractmixed

No codes listed

No numeric thresholds in excerpt

Numeric thresholds or limitsNo numeric thresholds, limits, or measurement cutoffs are present in this extract for PTH, calcium, phosphate, or magnesium testing.

Policy statement on thresholdsThe policy update notes that reimbursement information was revised for clarity but does not introduce any numeric thresholds in these chunks.

Implication for billing/codingClaims adjudication should follow coverage criteria rather than numeric test thresholds within this extract; providers may be asked for clinical documentation.

Documentation, Billing and Reimbursement Notes for Providers

Documentation Required

Documentation and coding requirements

Providers are responsible for submitting accurate documentation of services performed and must code claims using valid HIPAA‑approved code sets (for example CPT, HCPCS, ICD‑10). Claims are subject to code‑edit protocols and claim review; BCBSNM may request additional documentation and will apply applicable plan and contract terms when reviewing claims.

Submit claims using valid HIPAA‑approved code sets (CPT, HCPCS, ICD‑10, NDC, DRG, etc.).
Code appropriately per industry standards (UB, AMA CPT, CMS NCCI/CCI edits).
Be prepared to provide additional documentation upon request; claims are subject to claim review and code‑edit protocols.

Billing Rule

Reimbursement wording clarified (6/15/2023)

The policy was updated on 6/15/2023 to clarify reimbursement information; providers should consult the policy's reimbursement section for billing guidance and any changes resulting from that update.

Refer to the reimbursement section of this policy for current billing guidance.
Note the 6/15/2023 update revised reimbursement wording for clarity.

Definitions and Test Considerations

Serum intact PTH reimbursable indications

Hypercalcemia assessmentReimbursable: Serum intact PTH testing to assess for possible hyperparathyroidism in individuals with hypercalcemia.

Post‑operative monitoringReimbursable: To assess post‑operative results of parathyroid surgery.

Annual follow‑upReimbursable: As part of annual testing for individuals previously diagnosed with hyperparathyroidism.

CKD assessmentReimbursable: As part of assessment of chronic kidney disease (CKD).

Osteoporosis assessmentReimbursable: As part of assessment of osteoporosis.

Cancer careReimbursable: As part of diagnosis and/or assessment of cancer or cancer therapy.

Screening — exclusions (not reimbursable)

Screening for asymptomatic diseaseNot reimbursable: Serum intact PTH testing to screen for asymptomatic primary hyperparathyroidism.

Wellness/general exam without abnormalitiesNot reimbursable: Serum PTH (and related magnesium, phosphorus, and calcium tests) when performed as part of a wellness or general exam without abnormal findings.

PTH assay considerations

Assay trueness and precisionConsiderations include trueness and precision of PTH assays; third‑generation assays (e.g., LIAISON 1‑84) have published comparisons to existing intact PTH assays.

Assay stabilityStability of PTH assays is a relevant consideration for measurement validity and is discussed in published evaluations.

Priority for assay improvementProfessional perspectives recommend improvement priorities for PTH measurement methods (IFCC Working Group commentary).

Mineral homeostasis — calcium, phosphate, magnesium

Calcium roleCalcium is central to mineral homeostasis and influences PTH secretion; clinical guidance on hypocalcemia and related evaluation is cited.

Magnesium modulationMagnesium modulates PTH secretion and upregulates parathyroid receptor expression at moderately low calcium concentrations.

Phosphate interactionsPhosphate is integral to mineral homeostasis and is considered alongside calcium and magnesium in clinical evaluation and ordering tools.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyParathyroid Hormone, Phosphorous, Calcium and Magnesium Testing

Policy CodePolicy CPCPLAB055

Change TypeClarified reimbursement languagereferences revised

Effective DateJun 15, 2023

Next Review DateN/A

Key ActionProviders must submit accurate documentation and use valid HIPAA-approved code sets; claims are subject to review and additional documentation may be requested.

SourceLink

On This Page

OpenPayer

Parathyroid Hormone, Phosphorous, Calcium and Magnesium Testing

Coverage Criteria for PTH, Phosphorus, Calcium and Magnesium Testing

Procedure Codes and Coding Notes

Documentation, Billing and Reimbursement Notes for Providers

Definitions and Test Considerations