CurrentBlue KCPolicy POL-PP-292 AHS - G2099 - Intracellular Micronutrient Analysis

Intracellular Micronutrient Analysis

Defines Blue KC's payment stance for intracellular micronutrient panel testing and which provider lines of business and provider types are impacted.

Policy Summary

PayerBlue KC

PolicyIntracellular Micronutrient Analysis

Policy CodePolicy POL-PP-292 AHS - G2099 - Intracellular Micronutrient Analysis

Change TypeNo material changes

Effective Date07/01/2025

Next Review Date07/01/2026

Key ActionIntracellular micronutrient panel testing (e.g., SpectraCell, Cell Science Systems cell micronutrient assay, ExaTest) may not be reimbursed.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

07/01/2025Effective date

07/01/2026Next revision date

ActivePolicy status

Commercial, Medicare AdvantageLines of business impacted

Professional, Facility, LabProvider types impacted

Coverage Determination

Intracellular micronutrient panel testing

Coverage is dependent on member benefits and date of service. The policy finds lack of sufficient published scientific literature to support clinical benefit.

ALL of the following

Application of coverage criteria is dependent upon an individual's benefit coverage at the time of the request.
The following does not meet coverage criteria due to a lack of available published scientific literature confirming that the test(s) is/are required and beneficial for the diagnosis and treatment of an individual's illness.
Intracellular micronutrient panel testing (e.g., SpectraCell, Cell Science Systems cell micronutrient assay, ExaTest) may not be reimbursed.
Policy determination: not covered when requested for diagnosis or treatment due to insufficient published evidence.

Decision: Not covered

Intracellular micronutrient panel testing is considered not covered under this policy; applicability remains subject to member benefits and date of service.

CPT / HCPCS Codes

Associated CPT/HCPCS codes listed in policymixedNot Covered

82128	Amino acids; multiple, qualitative, each specimen
82136	Amino acids, 2 to 5 amino acids, quantitative, each specimen
82180	Ascorbic acid (vitamin c), blood
82310	Calcium; total
82379	Carnitine (total and free), quantitative each specimen
82495	Chromium
82525	Copper
82607	Cyanocobalamin (Vitamin B-12)
82652	Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed
82725	Fatty acids, nonesterified

1–10 of 26

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Provider Billing & Authorization Actions

Denial Risk

Prior authorization / denial risk — Intracellular micronutrient panels not reimbursed

Intracellular micronutrient panel testing (for example, SpectraCell, Cell Science Systems cell micronutrient assay, ExaTest) may not be reimbursed because the policy finds a lack of available published scientific literature confirming clinical benefit. Verify member benefits and date of service before ordering; prior authorization is unlikely to result in coverage when the service is for these panels.

Coverage is dependent on the member's benefits and date of service.
The policy states the tests do not meet coverage criteria due to insufficient published scientific literature confirming they are required and beneficial.

Definitions

Micronutrients — definition / short descriptor entry

DefinitionMicronutrients are dietary components — vitamins and minerals — required in small amounts that are not produced by the body and must be derived from the diet.

Examples - VitaminsEssential vitamins include vitamins A, B, C, D, and K.

Examples - Trace elementsEssential trace elements include zinc, selenium, manganese, copper, chromium, iron, iodine, molybdenum, cobalt, and boron.

RoleVital to development, disease prevention, and wellbeing.

Source referenceDefinitions and examples adapted from the policy’s Description/Application section citing CDC and WHO sources.