ModifiedBlue Cross Blue Shield - OklahomaPolicy CPCPLAB056

Gamma-glutamyl Transferase Testing in Adults

Defines reimbursement and laboratory management criteria for serum GGT testing in individuals 18 years and older; specifies clinical indications and frequency limits that affect provider billing and coverage.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyGamma-glutamyl Transferase Testing in Adults

Policy CodePolicy CPCPLAB056

Change TypeClarified age applicabilityliterature review updated

Effective DateJan 15, 2025

Next Review DateN/A

Key ActionEnsure documentation supports that the tested individual is 18 years of age or older when submitting claims for GGT testing.

SourceLink

POLICY UPDATE CHANGES

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

References were revised and literature review updated.

Policy title changed from previous wording to current 'Gamma-glutamyl Transferase'.

18+age group policy applies to

q2wkmax reimbursable frequency

1procedure codes listed

multiplereferences appended

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 Serum GGT Testing

inv-01: Reimbursable indications and frequency

Serum GGT testing may be reimbursable when performed no more than once every two weeks for the following:

Age requirement: Patient is 18 years of age or older18+

Policy is specific to individuals 18 years of age or older; criteria do not apply to individuals <18 years

Indications for GGT testing

Elevated alkaline phosphatase activitynone
GGT testing no more than once every two weeks may be reimbursable
Chronic alcohol usenone
Long-term drug therapy known to have a potential for causing liver toxicitynone
Exposure to hepatotoxinsnone
Viral hepatitis, amoebiasis, tuberculosis, psittacosis, or similar infections that may cause hepatic injurynone
Primary or secondary malignant neoplasmsnone
Diabetes mellitusnone
Malnutritionnone
Disorders of iron and mineral metabolismnone
Sarcoidosisnone
Amyloidosisnone
Lupusnone
Hypertensionnone
Gastrointestinal diseasenone
Pancreatic diseasenone
As part of liver function assessment subsequent to liver transplantationnone

inv-02: Not reimbursable (screening)

Asymptomatic screening: Serum GGT testing during a wellness visit or general exam without abnormal findingsnone

Not reimbursable.

Serum GGT testing performed in asymptomatic individuals during a wellness visit or general examination without any abnormal findings is explicitly excluded from reimbursement and considered non‑reimbursable under this policy.

This policy and its coverage criteria apply only to individuals who are 18 years of age or older. The criteria do not apply to individuals under 18 years of age; documentation should support the patient’s age when submitting claims.

Routine or screening serum GGT testing in asymptomatic individuals without abnormal findings is not reimbursable. Claims for such screening performed during routine exams or wellness visits are subject to denial.

When GGT Testing May Be Covered

inv-18: Elevated alkaline phosphatase activity

Elevated alkaline phosphatase activity: Serum GGT testing may be reimbursable when performed no more than once every two weeks for individuals with elevated alkaline phosphatase activityno more than once every 2 weeks

inv-19: Assessment for liver injury, function, and/or disease in presence of listed clinical conditions

Reimbursement condition

Chronic alcohol use
Long-term drug therapy known to have a potential for causing liver toxicity

Testing Frequency Limits

inv-21: serum GGT — no more than once every two weeks

Frequency limitSerum GGT testing: no more than once every two weeks (14 days)

Applicable populationApplies to individuals 18 years of age or older

Covered contextReimbursable when used for assessment of liver injury, function, and/or disease or with elevated alkaline phosphatase activity

inv-22: Frequency-related note (empty index placeholder)

Frequency placeholderPolicy specifies a maximum frequency of once every two weeks for reimbursable indications; see frequency limit in policy effective 01/15/2025

Age applicabilityCriteria apply only to individuals 18 years of age or older

Procedure Codes

Procedure Codes listedCPT

82977

Gamma-glutamyl transferase (GGT)

Provider Actions, Documentation, and Prior Authorization

Prior Authorization

Plan-specific prior authorization

Plan-specific prior authorization: Review plan- and product-specific requirements; not all requirements apply to every product. Providers should check the member's plan documents (e.g., benefit booklet, certificate of coverage) for coverage limitations or prior authorization rules that may affect reimbursement.

Check member plan documents for coverage and prior auth requirements
BCBSOK may apply plan-specific limits or require prior authorization for certain products

Note

Prior authorization

No prior authorization specified: This policy does not specify a universal prior authorization requirement for serum GGT testing. Absence of a prior authorization statement in this policy does not guarantee that prior authorization is not required under a specific member's plan.

Ordering and Product-Specific Requirements

Billing Rule

ORDERING REQUIREMENTS — verify plan and contract requirements and submit accurate claims

Review the member's plan documents and provider contract language to determine product-specific ordering and coverage requirements; ensure accurate documentation and valid codes are submitted with the claim.

Confirm whether any product-specific limits, prior authorization, or billing rules apply before performing or billing the test.

Note

ORDERING REQUIREMENTS — no ordering-provider restrictions specified

The provided policy excerpts do not state who may order GGT testing and do not impose ordering-provider restrictions.

If your plan or contract imposes ordering restrictions, follow those requirements; otherwise proceed per usual ordering practice and document clinical indication.

Background on GGT Testing

Gamma‑glutamyl transferase (GGT) is a serum enzyme used in the assessment of liver injury, liver function, and liver disease. Elevated GGT levels can occur with a variety of hepatic and systemic conditions (for example, alcohol‑related liver injury, drug‑related hepatotoxicity, infections, malignancy, metabolic disease, and post‑transplant assessment), and the test is used clinically to help evaluate these contexts when indicated.

inv-16: Definition — GGT testing for assessment of liver injury, function, and/or disease

Definition (term)GGT testing for assessment of liver injury, function, and/or disease

PurposeUsed to assess liver injury, liver function, and liver disease when clinical indications are present

Reimbursement contextMay be reimbursable no more than once every two weeks when one or more listed clinical conditions are present

inv-17: GGT — gamma-glutamyl transferase (definition/reference)

Full name

Tests and Indications Not Covered

Screening GGT testing in asymptomatic individuals during wellness visits or general physical examinations without abnormal findings is not covered and will not be reimbursed under this policy.

No additional explicit exclusions are listed in the provided excerpts beyond the age applicability note. The policy update history clarifies that the criteria apply only to individuals 18 years of age or older, and providers should review plan documents for any product‑specific requirements that could affect coverage.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyGamma-glutamyl Transferase Testing in Adults

Policy CodePolicy CPCPLAB056

Change TypeClarified age applicabilityliterature review updated

Effective DateJan 15, 2025

Next Review DateN/A

Key ActionEnsure documentation supports that the tested individual is 18 years of age or older when submitting claims for GGT testing.

SourceLink

On This Page

Exposure to hepatotoxins

Viral hepatitis, amoebiasis, tuberculosis, psittacosis, or similar infections that may cause hepatic injury

Primary or secondary malignant neoplasms

Disorders of iron and mineral metabolism

Gastrointestinal disease

As part of liver function assessment subsequent to liver transplantation

Non-reimbursable screening noteSerum GGT testing during wellness visits or general exams without abnormal findings is not reimbursable

Documentation Required

Provider action

Provider action: Providers must verify member eligibility and any plan-specific coverage rules before ordering tests. Submit supporting documentation on request to demonstrate medical necessity.

Documentation Required

Provider action

Provider action: When requested, furnish additional clinical documentation to support testing frequency and indication (e.g., history of alcohol use, hepatotoxic drug therapy, symptoms or diagnoses listed in criteria).

Billing Rule

Documentation and coding expectations

Documentation and coding expectations: Providers are responsible for accurate documentation and coding. Claims should be coded using valid code combinations from HIPAA-approved code sets and conform to standard coding guidelines. Upon request, providers must submit additional documentation to support the claim.

Use appropriate CPT/HCPCS/ICD-10 codes per industry standards
Retain and provide clinical records that justify test frequency and indication

Documentation Required

Age documentation

Age documentation: Document that the tested individual is 18 years of age or older. This policy's reimbursement criteria apply only to adults (≥18 years). Claims for individuals under 18 may be denied.

Policy applies only to individuals 18 years of age or older
Include date of birth on documentation to support age eligibility

Denial Risk

Non-reimbursable screening

Non-reimbursable screening: Serum GGT testing for asymptomatic individuals during wellness visits or general exams without abnormal findings is not reimbursable and may be denied when billed for routine screening.

Do not bill serum GGT for routine wellness visits or general exams without abnormal findings

Denial Risk

Age-based denial risk

Age-based denial risk: Claims for patients under 18 years of age are at risk for denial because the policy criteria are limited to adults.

Verify patient age; expect potential denial for < 18

GGT: gamma-glutamyl transferase

Clinical roleSerum enzyme measured to evaluate liver disease, alcohol-related liver injury, obstructive jaundice, NAFLD, and to help assess liver fibrosis

Literature sourcesPolicy references LabCorp and multiple literature sources supporting clinical indications and associations