CurrentBlue KCPolicy POL-PP-282

Gamma-glutamyl Transferase Testing in Adults

This policy governs reimbursement for serum GGT testing in individuals aged 18 and older for Blue KC lines of business and specifies clinical scenarios and frequency limits when testing is reimbursable.

Policy Summary

PayerBlue KC

PolicyGamma-glutamyl Transferase Testing in Adults

Policy CodePolicy POL-PP-282

Change TypeNo material change

Effective DateOct 1, 2025

Next Review DateOct 1, 2026

Key ActionOrder serum GGT testing only for individuals 18+ who meet listed clinical indications and limit reimbursement to no more than once every two weeks.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

18+age group covered by criteria

every 2 weeksmaximum reimbursable testing frequency

82977CPT code referenced for GGT

002policy version

Reimbursable indications and limits

Covered when ALL of the following are met:

Applies only to individuals 18 years of age or older.

ALL of the following

For individuals with elevated alkaline phosphatase activity, serum GGT testing is reimbursable no more than once every two weeks.No more than once every two weeks
Applies to elevated alkaline phosphatase scenario.
OR for assessment of liver injury/function/disease, reimbursable when at least ONE of the following clinical conditions is present:
- Chronic alcohol use.

Policy Summary

PayerBlue KC

PolicyGamma-glutamyl Transferase Testing in Adults

Policy CodePolicy POL-PP-282

Change TypeNo material change

Effective DateOct 1, 2025

Next Review DateOct 1, 2026

Key ActionOrder serum GGT testing only for individuals 18+ who meet listed clinical indications and limit reimbursement to no more than once every two weeks.

SourceLink

On This Page

GGT test coding and frequency

GGT serum testCPTCovered

82977

Glutamyltransferase, gamma (GGT)

Maximum reimbursable frequency

Frequency limitNo more than once every two weeks for indicated conditions

Applicable age groupApplies only to individuals 18 years or older

Reimbursable clinical contextsElevated alkaline phosphatase; assessment of liver injury/function for chronic alcohol use, long‑term hepatotoxic drug therapy, exposure to hepatotoxins, viral or other infections causing hepatic injury, malignancy of the digestive system, diabetes, malnutrition, disorders of iron/mineral metabolism, sarcoidosis, amyloidosis, lupus, hypertension, gastrointestinal or pancreatic disease, post‑liver transplant assessment

Not reimbursed scenarioAsymptomatic individuals during a wellness visit or general exam without abnormal findings

Reimbursement guidance and operational notes

Billing Rule

Reimbursement guidance and limit

• Prior authorization: Not required for routine serum GGT (CPT 82977). Confirm member’s benefit coverage and medical necessity before submitting claims. • Frequency limit: Reimbursement is allowed for serum GGT testing no more than once every two weeks when used to assess liver injury, function, or disease in individuals meeting the clinical criteria below. Tests submitted more frequently than every two weeks are at risk of denial. • Patient eligibility: This policy applies to individuals age 18 and older. Tests for asymptomatic individuals obtained during wellness visits or general exams without abnormal findings are not reimbursable. • Documentation: Clinical documentation must support one or more qualifying conditions (see items) and the medical necessity for testing at the submitted interval. Include relevant history (e.g., chronic alcohol use, hepatotoxic drug therapy, viral hepatitis, liver transplant follow-up), signs/symptoms, laboratory trends (elevated alkaline phosphatase or other abnormalities), and treatment plan. • Billing/Coding: Use CPT code 82977 for serum GGT. Do not report more frequent testing than allowed by benefit limits unless supported by documentation demonstrating medical necessity. • Denial risk: Claims lacking documentation of a qualifying condition, for members <18 years, or for asymptomatic screening during wellness/general exams may be denied.

Frequency limit: ≤ once every 2 weeks when criteria met
Applies to individuals ≥ 18 years
Not reimbursed for asymptomatic screening during wellness/general exams without abnormal findings
Qualifying conditions include: chronic alcohol use; long‑term hepatotoxic drug therapy; exposure to hepatotoxins; viral hepatitis, amoebiasis, tuberculosis, psittacosis or similar infections; primary/secondary malignant neoplasms of the digestive system; diabetes mellitus; malnutrition; disorders of iron and mineral metabolism; sarcoidosis; amyloidosis; lupus; hypertension; gastrointestinal or pancreatic disease; post‑liver transplantation follow‑up

Terminology

Gamma‑glutamyl transferase (GGT) — definition

Term / Alternate nameGamma‑glutamyl transferase (GGT), also known as gamma‑glutamyl transpeptidase (GGTP)

Biologic roleEnzyme present in cell membranes of many tissues (heart, brain, seminal vesicles, kidneys, bile duct, spleen, gallbladder)

Clinical useTraditionally a marker for liver dysfunction, bile duct disease, and alcohol use; emerging research links GGT to cardiovascular disease, gestational diabetes, infectious diseases, and various cancers

Half‑lifeBetween 14 and 26 days