CurrentBlue Cross Blue Shield - TexasPolicy CPCPLAB056

Gamma-glutamyl Transferase in Adults

Reimbursement criteria for serum GGT testing in individuals 18 years and older under Blue Cross Blue Shield of Texas lab management program; describes when GGT testing may be reimbursable and when it is not.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyGamma-glutamyl Transferase in Adults

Policy CodePolicy CPCPLAB056

Change TypeCriteria additions and clarifications (material)

Effective DateSep 26, 2025

Next Review Date

Key ActionSubmit claims with documentation supporting at least one listed clinical indication and limit testing to no more than once every two weeks when reimbursable.

SourceLink

POLICY UPDATE CHANGES

Added 'of the digestive system' to criterion 2e for individuals with primary or secondary malignant neoplasms.

Revised criterion 2.o. for clarity regarding assessment of liver function subsequent to liver transplantation.

Noted that the policy applies only to individuals 18 years of age or older.

References were revised following a literature review.

1/2wtesting frequency limit (reimbursable)

18+applicable age

>=1clinical indications required

wellnessnon-reimbursable setting

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyGamma-glutamyl Transferase in Adults

Policy CodePolicy CPCPLAB056

Change TypeCriteria additions and clarifications (material)

Effective DateSep 26, 2025

Next Review Date

Key ActionSubmit claims with documentation supporting at least one listed clinical indication and limit testing to no more than once every two weeks when reimbursable.

SourceLink

On This Page

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Reimbursable Criteria for Serum GGT Testing

Reimbursable Criteria

Reimbursable serum GGT testing (individuals 18 years of age or older):

Applies only to individuals 18 years of age or older.

Serum GGT testing no more than once every two weeks may be reimbursable when criteria below are met.

Indication requirement

ANY of the following
- Chronic alcohol use.
- Long-term drug therapy known to have a 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 of the digestive system.
- Diabetes mellitus.
- Malnutrition.
- Disorders of iron and mineral metabolism.
- Sarcoidosis.
- Amyloidosis.
- Lupus.
- Hypertension.
- Gastrointestinal disease.
- Pancreatic disease.
- Assessment of liver function subsequent to liver transplantation.

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

Procedure Codes and Frequency Limits

Procedure codesmixed

No codes listed

inv-03: Maximum testing frequency

Maximum testing frequencySerum GGT testing reimbursable no more than once every two weeks when criteria are met.

ScopeApplies to reimbursable GGT testing for elevated alkaline phosphatase and to assessments of liver injury, function, or disease when at least one listed indication is present.

Application noteLimit applies per individual — testing repeated sooner than every two weeks is not considered reimbursable under this policy.

Billing, Documentation, and Claims Submission

Documentation Required

Provider billing and documentation expectations

Providers must submit accurate, complete documentation and bill using valid HIPAA code sets. Claims should be coded in accordance with industry-standard coding guidelines (e.g., UB, AMA CPT, CPT® Assistant, HCPCS, ICD-10-CM/PCS, NDCs, DRG guidelines, CMS NCCI policy manual and CCI edits). Blue Cross and Blue Shield of Texas (BCBSTX) may interpret and apply this policy with reasonable discretion; where conflicts exist, the applicable plan document or provider contract governs.

Submit supporting clinical documentation upon request.
Use only valid code combinations from HIPAA-approved code sets.
Code according to industry-standard coding guidance (UB, AMA CPT, HCPCS, ICD-10, NDC, DRG, CMS NCCI/CCI).

Billing Rule

Key Definitions

inv-06: Adult

DefinitionAdult = an individual 18 years of age or older to whom this policy's reimbursement criteria apply.

Age applicability noteCriteria and reimbursement rules in this policy do not apply to individuals less than 18 years of age.

Policy scopeApplies to all adults under the Plan unless a specific plan document or provider contract states otherwise.

inv-07: Asymptomatic wellness testing

DefinitionAsymptomatic wellness testing = serum GGT testing performed during a wellness visit or general exam in an individual without abnormal findings.

Reimbursement stanceSerum GGT testing in this scenario is not reimbursable under this policy.