ModifiedBlue Cross Blue Shield - TexasPolicy CPCPLAB056

Gamma-glutamyl Transferase in Adults

Laboratory reimbursement and utilization criteria for serum GGT testing in individuals 18 years and older under Blue Cross Blue Shield of Texas products; defines reimbursable indications and frequency limits. Applies to providers submitting claims for GGT testing.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyGamma-glutamyl Transferase in Adults

Policy CodePolicy CPCPLAB056

Change TypeAge applicability clarifiedreferences updated

Effective DateFeb 5, 2025

Next Review DateN/A

Key ActionVerify that GGT testing claims are supported by documentation of an indicated clinical condition and that the patient is 18 years or older.

SourceLink

POLICY UPDATE CHANGES

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

References revised.

Title changed from Gamma-glutamyl Transferase.

Document updated with literature review.

02/05/2025effective

82977code

≤1/2wkfrequency

Excludedwellness

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Coverage Criteria

Reimbursable Indications and Frequency

Covered when ALL of the following are met:

Age: Individual is 18 years of age or olderage >= 18

Policy specific to adults

Reimbursable clinical indications (one or more required)

Elevated alkaline phosphatase: For individuals with elevated alkaline phosphatase activity, serum GGT testing no more than once every two weeks may be reimbursable.<=1 per 2 weeks
See policy note on frequency
Clinical conditions: Chronic alcohol use; long-term drug therapy known to have potential for causing liver toxicity; exposure to hepatotoxins; viral hepatitis, amoebiasis, tuberculosis, psittacosis, or similar infections that may cause hepatic injury; primary or secondary malignant neoplasms; diabetes mellitus; malnutrition; disorders of iron and mineral metabolism; sarcoidosis; amyloidosis; lupus; hypertension; gastrointestinal disease; pancreatic disease; as part of liver function assessment subsequent to liver transplantation.<=1 per 2 weeks
Any one listed condition meets this element

Frequency limit: Testing reimbursable no more than once every two weeks for the indicated conditions<=1 per 2 weeks

Applies to elevated alkaline phosphatase and the listed clinical indications

Serum GGT testing performed on asymptomatic individuals as part of a routine wellness visit or general exam when there are no abnormal findings is not reimbursable. Claims submitted for screening GGT in these circumstances may be denied.

This policy and its coverage criteria apply only to individuals 18 years of age or older. The criteria do not apply to persons less than 18 years of age; the reimbursement information was updated to add this age-specific clarification.

Screening GGT testing in asymptomatic persons without abnormal findings (for example, routine wellness exams or general health checks) is considered not reimbursable. Use of serum GGT for screening in the absence of clinical indications is excluded from coverage.

Covered Indications

Elevated alkaline phosphatase activity

Covered when ALL of the following are met:

Age: Individual is 18 years of age or olderage >= 18

Policy specific to adults

Indication: Elevated alkaline phosphatase activity

Serum GGT testing may be reimbursable to evaluate the cause of elevated alkaline phosphatase

Frequency limit: Testing reimbursable no more than once every two weeks<=1 per 2 weeks

Frequency applies for evaluation of elevated alkaline phosphatase

Frequency Limits

inv-20: Serum GGT — No more than once every two weeks

Maximum reimbursable frequencySerum GGT testing reimbursable no more than once every two weeks (≤1 test per 2 weeks)

Applies toIndividuals 18 years of age or older

Clinical context for frequency limitFrequency limit applies when evaluating elevated alkaline phosphatase activity or to assess liver injury, function, and/or disease for listed conditions

Not Covered

Serum GGT testing conducted during a wellness visit or general examination for asymptomatic individuals with no abnormal findings is explicitly not covered and will not be reimbursed.

The policy’s reimbursement information was clarified to specify that the coverage criteria apply only to individuals 18 years or older. Claims for patients under age 18 are outside the scope of these criteria and may be subject to denial or alternative policy review.

Coding

Procedure CodesCPT

82977

Gamma-glutamyl transferase (GGT)

Provider Actions

Prior Authorization

Verify plan-specific prior authorization — reimbursement governed by plan documents and lab management criteria

Verify plan-specific prior authorization and reimbursement rules before ordering. Reimbursement is governed by the member's plan documents and any applicable lab management criteria; when plan documents or provider contracts conflict with this clinical payment and coding policy, the plan document or provider contract will govern.

Plan documents (e.g., Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions) may impose different coverage limits.
Providers should confirm product-specific lab management requirements prior to service.
BCBSTX retains discretionary authority to interpret and apply this policy consistent with plan documents.

Note

Policy applies to individuals 18 years of age or older

This policy and its reimbursement criteria apply only to individuals 18 years of age or older. Do not apply these criteria to individuals under 18; reimbursement determinations for members under 18 should be made per the applicable plan documents and clinical policies.

Ordering Requirements

Step Therapy

ORDERING REQUIREMENTS — verify plan and coding guidance

Providers must follow plan documents and coding guidance when ordering GGT testing and verify any product-specific coverage, reimbursement rules, or ordering restrictions with the plan before performing testing.

Plan documents govern in case of conflict with this policy.
The plan has implemented lab management reimbursement criteria; not all requirements apply to every product.

Background

Gamma‑glutamyl transferase (GGT) is a serum enzyme measured to assess liver injury, liver function, and hepatic disease. GGT levels can be elevated with biliary obstruction, hepatotoxic exposure, chronic alcohol use, certain infections, malignancy, metabolic disorders, and other systemic conditions. The test is used clinically to help evaluate the cause of abnormal liver-related laboratory results and to monitor liver-related conditions when indicated.

Definitions

inv-15: GGT — Serum GGT testing (compact definition)

Test name and codeGamma‑glutamyl transferase (GGT), CPT 82977

Specimen typeSerum

Primary useBiochemical assay to evaluate liver injury, function, and biliary disease

inv-16: GGT — Gamma-glutamyl transferase definition and clinical context per cited literature

DefinitionGamma‑glutamyl transferase (GGT) — a serum enzyme measured to assess liver function and as a biomarker in various hepatic and systemic conditions.

Clinical contexts citedUsed in evaluation of liver disease, fibrosis prediction, prognosis in hepatocellular carcinoma, and associations with vascular and neurodegenerative conditions (per literature).

Revision History

2025-02-05updateLatest

Effective date 02/05/2025; reimbursement information updated including addition of age applicability clarification that policy applies only to individuals 18 years or older; references revised; title changed from 'Gamma-glutamyl Transferase'; document updated with literature review.

2024-09-13new_policy

New policy established with effective date 09/13/2024 and planned summary of changes date 01/01/2025.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyGamma-glutamyl Transferase in Adults

Policy CodePolicy CPCPLAB056

Change TypeAge applicability clarifiedreferences updated

Effective DateFeb 5, 2025

Next Review DateN/A

Key ActionVerify that GGT testing claims are supported by documentation of an indicated clinical condition and that the patient is 18 years or older.

SourceLink

On This Page

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

Age: Individual is 18 years of age or olderage >= 18

Policy specific to adults

At least one clinical condition present

Chronic alcohol use
Hepatotoxic drug therapy: Long-term drug therapy known to have potential for causing liver toxicity
Hepatotoxin exposure: Exposure to hepatotoxins
Infections causing hepatic injury: Viral hepatitis, amoebiasis, tuberculosis, psittacosis, or similar infections that may cause hepatic injury
Malignancy: Primary or secondary malignant neoplasms
Diabetes mellitus
Malnutrition
Iron/mineral metabolism disorders: Disorders of iron and mineral metabolism
Sarcoidosis
Amyloidosis
Lupus
Hypertension
Gastrointestinal disease
Pancreatic disease
Post-transplant assessment: As part of liver function assessment subsequent to liver transplantation

Frequency limit: Testing reimbursable no more than once every two weeks for the listed clinical conditions<=1 per 2 weeks

Applies when at least one listed condition is present

Literature-cited uses of GGT testing as biomarker in liver disease, fibrosis prediction, prognosis, and associations with other conditions

Policy references literature describing clinical and biomarker roles of GGT in hepatic and systemic conditions.

Literature-cited uses: GGT has been reported in the literature as a biochemical marker in: evaluation of liver disease and prediction of fibrosis; prognostic assessment in hepatocellular carcinoma; associations with vascular disease, stroke outcomes, intracranial arterial calcification, and atrial fibrillation; and associations with neurodegenerative disorders such as Alzheimer's and Parkinson's disease.

See cited references for details

Selected referenced findings: Representative citations include studies and reviews on GGT in alcohol-related liver disease, GGT-to-platelet ratio for fibrosis prediction, associations with metabolic syndrome, prognostic value in hepatocellular carcinoma, and links to stroke and neurodegenerative disease outcomes.

References: Thursz et al. 2018; Wang et al. 2016/2017; Xing et al. 2022; Xu et al. 2017; Yao et al. 2019; Yavuz et al. 2008; Yoo et al. 2020; Wang et al. 2014.

Effective 02/05/2025: Reimbursement information updated to clarify age applicability to individuals >= 18 years.
Claims for members under 18 should be reviewed against the member's plan document for coverage determinations.

Documentation Required

Clinical indication documentation required

Providers must document medical necessity for GGT testing. Submit supporting clinical documentation with the claim to demonstrate that testing meets the listed reimbursement criteria.

Document the clinical indication (e.g., elevated alkaline phosphatase, signs of liver injury) and relevant history (alcohol use, hepatotoxic medication, infections, transplant status, metabolic or systemic diseases).
Providers are responsible for submission of accurate documentation and may be asked to provide additional records upon request.

Denial Risk

Denial for screening/wellness testing

Denial risk for screening/wellness testing: serum GGT testing performed during a wellness visit or general exam for asymptomatic individuals without abnormal findings is not reimbursable and may be denied.

Asymptomatic screening or routine wellness testing without abnormal clinical findings may be denied as not medically necessary.
If testing is ordered due to an abnormal finding or documented clinical concern, include that documentation with the claim to support reimbursement.

Billing Rule

Reimbursement information was updated to specify frequency and qualifying indications

Reimbursement information summary — updated operational guidance on frequency and indications for serum GGT testing for individuals 18 years and older.

For individuals with elevated alkaline phosphatase activity, serum GGT testing no more than once every two weeks may be reimbursable.
To assess liver injury, function, and/or disease, serum GGT testing no more than once every two weeks may be reimbursable when at least one qualifying condition is present (e.g., chronic alcohol use; long-term hepatotoxic drug therapy; exposure to hepatotoxins; viral hepatitis or other infections causing hepatic injury; primary/secondary malignant neoplasms; diabetes mellitus; malnutrition; iron/mineral metabolism disorders; sarcoidosis; amyloidosis; lupus; hypertension; gastrointestinal or pancreatic disease; post-liver transplant assessment).
This policy does not apply to individuals under 18 years of age.

Common causes of elevationBiliary obstruction, hepatotoxic exposure, chronic alcohol use, hepatotoxic drugs, infections, malignancy, metabolic and systemic diseases.

Relevant literatureMultiple references supporting use and associations (EASL guidelines; studies on GGT and fibrosis, HCC prognosis, stroke and neurodegenerative links).