Covered when ANY of the following clinical scenarios apply (each bullet is an independent covered indication unless otherwise specified):
Signs or symptoms of hypothyroidism: TSH testing to confirm or rule out primary hypothyroidism; free T4 (fT4) testing as follow-up to abnormal TSH; TSH and fT4 testing for suspected secondary hypothyroidism; monitoring for individuals treated for primary hypothyroidism with TSH and fT4 every 6 weeks after dosage change and annually if stable; for secondary hypothyroidism monitor with fT4 every 6 weeks after dosage change and annually if stable.
See Note 1 for symptom list
Signs or symptoms of hyperthyroidism: TSH testing to confirm or rule out overt hyperthyroidism; fT4 testing as follow-up to abnormal TSH; total T3 (TT3) or free T3 (fT3) testing to confirm a diagnosis of hyperthyroidism; fT4 testing to distinguish overt versus subclinical hyperthyroidism; monitoring after treatment with repeat TSH and fT4 every 8 weeks during treatment and annual monitoring after the first year for relapse risk or late-onset hypothyroidism.
See Note 2 for symptom list
Medications that interfere with thyroid function: Asymptomatic individuals prescribed drugs known to interfere with thyroid function: TSH testing annually, when dosage/medication changes, or if symptoms develop.
Individuals capable of becoming pregnant: TSH testing for individuals undergoing evaluation for infertility or who have experienced two or more pregnancy losses.
One-time screening for high-risk asymptomatic individuals: One-time TSH screening for asymptomatic individuals at high risk due to personal or family history of thyroid dysfunction, type 1 diabetes, or other autoimmune disease.
Thyroid or other endocrine disease/neoplasm: Testing for individuals with disease or neoplasm of the thyroid or other endocrine glands.
Chronic or acute urticaria: TSH testing may be reimbursable for individuals with chronic or acute urticaria.
Pediatric indications: TSH testing for pediatric individuals with short stature or failure-to-thrive; for hypothalamic-pituitary disease monitor TSH and fT4 biannually if <18 years and annually if ≥18 years.
Immune reconstitution therapy (IRT): TSH testing every 3 months with reflex fT4 and fT3 when TSH is abnormal for individuals undergoing IRT (e.g., alemtuzumab for MS, HIV on HAART, post allogeneic BMT/HSCT).
Pregnancy or postpartum with symptoms: For pregnant or postpartum individuals with symptoms of thyroid dysfunction, TSH and fT4 testing once every 4 weeks may be reimbursable; for pregnant/postpartum individuals diagnosed with hyperthyroidism, TT4, Tg-Ab, TRab, and TPOAb may be reimbursable.
See Note 3 for pregnancy laboratory reporting requirements
Thyroid cancer surveillance: Serum thyroglobulin and/or thyroglobulin antibody testing for detection of tumor recurrence, post-surgical evaluation, surveillance, and maintenance for differentiated thyroid carcinomas may be reimbursable.
Primary mitochondrial disease: Annual screening of TSH and fT4 for individuals diagnosed with primary mitochondrial disease.