CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLABOS6

Gamma-glutamyl Transferase (GGT) Testing in Adults

This clinical payment and coding policy defines reimbursement criteria for serum Gamma-glutamyl Transferase (GGT) testing in individuals aged 18 years and older, including indications, allowable frequency, and non-reimbursable use during wellness/asymptomatic visits. It applies to BCBS Oklahoma lab management and may vary by product.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyGamma-glutamyl Transferase (GGT) Testing in Adults

Policy CodePolicy CPCPLABOS6

Change TypeRevised (multiple updates)

Effective DateJan 3, 2026

Next Review Date

Key ActionDocument one or more qualifying clinical indications and apply age and frequency limits (adult-only; no more than once every two weeks) to support reimbursement.

POLICY UPDATE CHANGES

09/26/2025 update; clarified language in Reimbursement Information; references revised.

10/30/2024 update; Note added clarifying adult-only applicability.

11/01/2023 update.

11/01/2022 Effective Date; new policy.

1Adult-only policy

14Listed qualifying indications

2Frequency rule (weeks)

Policy summary

Policy subject: Gamma-glutamyl Transferase (GGT) Testing in Adults; Policy number: CPCPLABOS6. This BCBS Oklahoma lab management reimbursement policy defines when serum GGT testing for adults is eligible for reimbursement, aligning testing frequency and clinical indications with utilization management and current clinical guidelines and literature.

Scope: This policy applies only to individuals 18 years of age or older and may vary by product. It covers allowable clinical indications (e.g., elevated alkaline phosphatase, chronic alcohol use, exposure to hepatotoxins, diabetes, primary or secondary malignant neoplasms of the digestive system, liver transplantation follow-up, and other listed conditions), specifies an allowable testing frequency of no more than once every two weeks for indicated reasons, and excludes reimbursement for serum GGT testing performed during asymptomatic wellness visits or general exams without abnormal findings.

Policy metadata

Effective Date2026-01-03

Last Review2025-09-26

Next Review

Policy NumberCPCPLABOS6

SubjectGamma-glutamyl Transferase (GGT) Testing in Adults

Scope SummaryReimbursement criteria for serum GGT testing in individuals aged 18 years and older, including indications, allowable frequency, and non-reimbursable use during wellness/asymptomatic visits; applies to BCBS Oklahoma lab management and may vary by product.

Adult-only policy1

Reimbursement criteria

Age applicability

Policy is specific to adults:

Individual is 18 years of age or older

Criteria below do not apply to individuals less than 18 years of age.

Reimbursable: Elevated alkaline phosphatase

Serum GGT testing may be reimbursable when the following condition is met:

Individual has elevated alkaline phosphatase activityNo more than once every two weeks

GGT testing reimbursable no more than once every two weeks.

Reimbursable: To assess for liver injury, function, and/or disease

Serum GGT testing may be reimbursable no more than once every two weeks when the individual has at least ONE of the following:

ONE of

Chronic alcohol use
Exposure to hepatotoxins
Long-term drug therapy known to have a potential for causing liver toxicity
Viral hepatitis, amoebiasis, tuberculosis, psittacosis, or similar infections that may cause hepatic injury
Diabetes mellitus
Primary or secondary malignant neoplasms of the digestive system

Not reimbursable

Circumstances where serum GGT testing is not reimbursable:

Asymptomatic individuals during a wellness visit or general exam without abnormal findings

Serum GGT testing during a wellness visit or a general exam without abnormal findings is not reimbursable.

Frequency and thresholds

Testing frequencyNo more than once every two weeks

Frequency rule (weeks)2

Billing, documentation & denial risks

Billing Rule

Age restriction

Apply reimbursement criteria only for individuals aged 18 years and older; tests for individuals <18 years are not governed by this policy.

Billing Rule

Frequency limitation

Limit serum GGT testing reimbursement to no more than once every two weeks for indicated clinical reasons.

Documentation Required

Indication documentation

Document one or more qualifying clinical indications to support reimbursement.

Elevated alkaline phosphatase
Chronic alcohol use
Exposure to hepatotoxins
Diabetes mellitus
To assess liver function subsequent to liver transplantation
Primary or secondary malignant neoplasms of the digestive system
Malnutrition
Disorders of iron and mineral metabolism
Sarcoidosis
Amyloidosis
Hypertension
Lupus
Gastrointestinal disease
Pancreatic disease

Denial Risk

Wellness visit denial risk

Claims for serum GGT performed during asymptomatic wellness visits or general exams without abnormal findings are not reimbursable and may be denied.

Policy changes

2022-11-01added

Effective Date - new policy created

2023-11-01revised

Removed drug ingestion from indication 2a; added frequency limits to indications (testing no more than once every two weeks); other clarity edits

2024-10-30revised

Note added clarifying policy applies only to individuals ages 18 years and older; references revised; title changed

2025-09-26revisedLatest

Clarified language in Reimbursement Information by adding 'of the digestive system' to malignant neoplasm indication; reimbursement information phrasing and references revised; updated approval and plan effective dates