CurrentBlue Cross Blue Shield - TexasPolicy CPCPLABO56

Gamma-glutamyl Transferase in Adults

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Defines reimbursement and lab management criteria for serum GGT testing in individuals aged 18 years and older for Blue Cross Blue Shield - Texas; applies to providers submitting claims for adult members.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyGamma-glutamyl Transferase in Adults

Policy CodePolicy CPCPLABO56

Change TypeAge applicability addedreferences updated

Effective DateMay 15, 2025

Last ReviewFeb 5, 2025

Next Review Date

Key ActionSubmit claims using valid code combinations and include appropriate documentation to support medical necessity for GGT testing in adults.

SourceLink

POLICY UPDATE CHANGES

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

Document updated with literature review and references revised.

>=18age applicability (adults only)

1/2wmax frequency

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CurrentBlue Cross Blue Shield - TexasPolicy CPCPLABO56

Gamma-glutamyl Transferase in Adults

Customize your policy alerts

Sign up for Blue Cross Blue Shield - Texas Policy CPCPLABO56 alerts

Get alerted when Policy CPCPLABO56 changes without checking for updates manually.

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Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyGamma-glutamyl Transferase in Adults

Policy CodePolicy CPCPLABO56

Change TypeAge applicability addedreferences updated

Effective DateMay 15, 2025

Last ReviewFeb 5, 2025

Next Review Date

Key ActionSubmit claims using valid code combinations and include appropriate documentation to support medical necessity for GGT testing in adults.

SourceLink

POLICY UPDATE CHANGES

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

Document updated with literature review and references revised.

>=18age applicability (adults only)

1/2wmax frequency

Coverage Criteria and Indications

Reimbursable indications and limits

Covered when ALL of the following are met

Adult requirement: Patient is 18 years of age or olderage >= 18

Policy applies only to adults as specified

Frequency limit: Serum GGT testing is reimbursable no more than once every two weeks<=1 test per 2 weeks

Applies when clinical indications below are present

Clinical indications: At least one of the following indications is present>=1 indication

List taken from reimbursement information

Serum GGT testing for asymptomatic individuals performed during a wellness visit or general physical examination without abnormal findings is excluded from reimbursement under this policy for adults (≥18 years).

Screening with serum GGT in asymptomatic individuals during routine wellness visits or general exams when there are no abnormal clinical or laboratory findings is considered not reimbursable / not medically necessary under this policy.

Covered Indications for GGT Testing

Evaluation of elevated alkaline phosphatase activity

For the indication below, tests are subject to the stated frequency limit.

Indication: Evaluation of elevated alkaline phosphatase activity

Serum GGT reimbursable no more than once every two weeks for this indication

Frequency limit: No more than once every two weeks<=1 test per 2 weeks

Applies to evaluation of elevated alkaline phosphatase activity

Assessment for liver injury, function, and/or disease when at least one listed clinical condition is present

Covered when at least ONE of the following clinical conditions is present (serum GGT testing reimbursable no more than once every two weeks).

Coding and Reimbursement Details

Procedure CodesCPT

82977

Gamma-glutamyl transferase (GGT) test code as listed in the procedure codes section

inv-05: Reimbursement frequency — no more than once every two weeks

Maximum reimbursable frequencyNo more than once every two weeks

Applies toIndividuals 18 years of age or older

Context of limitLimit applies when clinical indications (eg, elevated alkaline phosphatase or listed liver-related conditions) are present

Provider Actions, Claims, and Documentation

Billing Rule

Coding and claim submission — inclusion does not guarantee reimbursement

Submit claims using valid code combinations and industry-standard coding guidelines; listing CPT code 82977 does not guarantee reimbursement. Providers must code appropriately when billing for serum GGT testing.

Inclusion of a code in the procedure list is not a guarantee of coverage or payment.
Follow HIPAA-approved code sets and industry coding guidance when preparing claims.

Note

Bill only when clinical criteria and frequency limits are met

Ensure claims for serum GGT (CPT 82977) are billed only when documentation meets the policy's clinical criteria (adult patient, applicable indications, and frequency limits) to reduce denials and payment delays.

Not Covered

GGT testing performed for adults during wellness visits or general exams in the absence of symptoms or abnormal findings is not covered and will not be reimbursed.

Frequency Limits

inv-14: Serum GGT — No more than once every two weeks

Test nameSerum GGT (Gamma‑glutamyl transferase)

Reimbursement frequencyNo more than once every two weeks

Not reimbursable whenPerformed for asymptomatic individuals during a wellness visit or general exam without abnormal findings

Ordering Requirements

Prior Authorization

Ordering requirements — follow plan documents and provide accurate documentation

The policy does not specify which provider types are authorized to order GGT testing; follow the applicable plan documents and submit complete, accurate documentation with the claim.

Consult member benefit documents or provider contracts to confirm ordering privileges.
Claims may be reviewed per plan/contract terms; ensure documentation supports the ordered test.

Definitions

inv-11: GGT — Serum GGT testing definition

DefinitionSerum GGT testing (Gamma‑glutamyl transferase)

Clinical roleUsed to assess liver injury, function, and disease; may be elevated in alcohol use, hepatotoxic drug therapy, infections, hepatotoxin exposure, malignancy, metabolic disorders, and pancreatic conditions

Associated CPT code82977

Background

Gamma-glutamyl transferase (GGT) is a serum enzyme used in the assessment of liver injury, function, and disease. It can be elevated with chronic alcohol use, hepatotoxic drug therapy, viral or other infections that cause hepatic injury, exposure to hepatotoxins, primary or secondary malignancy, metabolic disorders such as diabetes and malnutrition, disorders of iron and mineral metabolism, and systemic conditions (eg, sarcoidosis, amyloidosis, lupus). When alkaline phosphatase is elevated, concurrent GGT can help distinguish a hepatic source from a bone source. Under this policy, GGT testing may be reimbursable for adults with appropriate clinical indications and is limited to no more than once every two weeks when those indications are present.