ModifiedEmblemHealthPolicy AHS-G2173

Gamma-glutamyl Transferase Testing in Adults

This Lab Benefit Program (LBM) reimbursement policy governs coverage criteria for serum GGT testing in adults (age ≥18) and describes indications, limitations, and frequency rules for EmblemHealth products.

Policy Summary

PayerEmblemHealth

PolicyGamma-glutamyl Transferase Testing in Adults

Policy CodePolicy AHS-G2173

Change TypeCoverage criteria clarifiedLBM scope expanded

Effective DateMar 1, 2023

Next Review DateN/A

Key ActionFollow billing and claims payment policies on emblemhealth.com and use CPT 82977 for GGT testing when submitting claims under the Lab Benefit Program.

SourceLink

POLICY UPDATE CHANGES

Title changed to specify testing is for adults and a disclaimer was added to Section III; Coverage Criteria 1 & 2 were simplified to remove age references.

Lab Benefit Program (LBM) was expanded to include EmblemHealth HMO/PPO (Non-City) Commercial, Medicare and Medicaid plans effective 10/1/2024.

Coverage criteria updated for clarity and consistency; removal of drug ingestion from Coverage Criterion 2.a and frequency changes to Coverage Criteria 1 & 2 with effective date 1/13/2024.

≥18policy applies to adults only

every 2 weeksmax recommended frequency

AHS-G2173policy identifier

10/01/2024

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

LBM expansion effective

Coverage criteria for GGT testing

Coverage criteria for GGT testing — adults (≥18)

Coverage is for adults (≥18) and depends on the individual's benefit coverage and applicable state/federal rules.

Applies only to individuals 18 years of age or older (criteria do not apply to individuals <18).

MEETS COVERAGE CRITERIA when ANY of the following are true:

For individuals with elevated alkaline phosphatase activity, serum GGT testing no more than once every two weeks.
ALL of the following
- At least one of the following 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 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.
  - To assess liver function subsequent to liver transplantation.

For asymptomatic individuals, serum GGT testing during a wellness visit or general exam without abnormal findings DOES NOT MEET COVERAGE CRITERIA.

Application of these coverage criteria is dependent upon the individual's benefit coverage at the time of the request; Medicare/Medicaid specifications and applicable government determinations may supersede this policy.

Guideline-based clinical indications and cautions

Guideline-based recommended uses and caveats for GGT measurement described by referenced professional societies:

American College of Gastroenterology (ACG) recommendations: Repeat the liver panel and/or perform a clarifying test (e.g., GGT) to confirm abnormal liver chemistries; use GGT to confirm hepatic origin of isolated alkaline phosphatase elevation; do not use GGT as a standalone screening test for liver disease due to lack of specificity; GGT may complement identification of alcohol use patterns but is not diagnostic of alcoholic liver disease.

Practice note (policy text): GGT is often elevated in alcoholic patients and can be elevated in pancreatic disease, myocardial infarction, renal failure, emphysema, diabetes, and with certain medications; given lack of specificity, GGT should not be used for screening in the absence of abnormal liver chemistries; isolated ALP elevation should be confirmed with GGT and, if elevated, consider liver ultrasound.

Canadian Association of Gastroenterology (CAG): GGT may be used as a second-line biochemical test; patients with any abnormal ALT, AST, or ALP should have GGT measured alongside albumin, bilirubin and PT/INR; these tests may be performed as initial screening if follow-up is impractical.

Coverage criteria and scope — limits, program management, and recent revisions

Coverage is limited to gamma‑glutamyl transferase testing in adults and is managed under the Lab Benefit Program (LBM); recent revisions clarified scope and expanded program coverage.

Policy scope: Applies to gamma‑glutamyl transferase testing in adults (18+); criteria were simplified and the title changed to specify adult testing.

Program scope: Managed under the Lab Benefit Program (LBM); LBM expanded to include additional EmblemHealth HMO/PPO (Non‑City) Commercial, Medicare and Medicaid plans effective 10/1/2024.

Policy changes: Removal of drug ingestion from Coverage Criterion 2.a and frequency changes to Coverage Criteria 1 & 2 were implemented effective 1/13/2024.

Billing/coding: Use CPT code 82977 for GGT testing as referenced in the policy's procedure codes section.

Coding and frequency guidance

Coding guidancemixed

Policy references following CPT and CMS coding edits and use of claims editing software; specific CPT/HCPCS codes not listed in this section.

Laboratory-developed tests (LDT) regulatory classificationmixed

No codes listed

GGT procedure codesCPTCovered

82977

Glutamyltransferase, gamma (GGT)

Testing frequency threshold

Maximum frequencyNo more than once every two weeks when meeting coverage criteria

ApplicabilityApplies when coverage criteria are met for adults (age ≥18)

ExceptionsAsymptomatic individuals during wellness visits without abnormal findings are not covered (see policy)

Billing, prior authorization, and provider guidance

Billing Rule

Billing and claims guidance / potential denials

Follow current billing and claims payment policies for all products unless otherwise noted. We will inform providers of policy additions or changes via postings to the applicable Reimbursement Policies webpages and through provider manuals and newsletters. The information in this policy is accurate as of the publication date but may not address every reimbursement scenario; other factors (legislative mandates, provider contracts, member benefit documents, other reimbursement or medical/drug policies) may supplement, modify, or supersede this policy. We follow industry coding edits (e.g., CPT guidance, CMS NCCI/MUE) and use standard claims-editing software. If appropriate coding/billing guidelines or current reimbursement policies are not followed, claims may be denied and/or payment recouped. Upon request, we will explain how specific coding issues are handled.

Current billing and claims payment policies apply to all products unless otherwise noted.
Policy changes announced via Reimbursement Policies webpages, provider manual, and provider newsletters.
Claims may be denied or recouped if coding/billing guidelines are not followed; explanations available upon request.

Definitions and abbreviations

Gamma‑glutamyl transferase (GGT)

TermGamma‑glutamyl transferase (GGT)

DefinitionAn enzyme measured in serum used as a marker of liver dysfunction, bile duct disease, and alcohol use; may be associated with metabolic, renal, pancreatic, and cardiovascular conditions.

Use under policyCovered in adults when meeting LBM criteria to help confirm hepatic origin of isolated ALP elevation or assess liver injury/disease.

Lab Benefit Program (LBM)

TermLab Benefit Program (LBM)

DefinitionThe EmblemHealth program under which serum GGT testing reimbursement and coverage criteria are managed.

Policy Summary

PayerEmblemHealth

PolicyGamma-glutamyl Transferase Testing in Adults

Policy CodePolicy AHS-G2173

Change TypeCoverage criteria clarifiedLBM scope expanded

Effective DateMar 1, 2023

Next Review DateN/A

Key ActionFollow billing and claims payment policies on emblemhealth.com and use CPT 82977 for GGT testing when submitting claims under the Lab Benefit Program.

SourceLink

On This Page

American Society of Addiction Medicine (ASAM): Measure GGT and ALT to identify recent heavy alcohol use and risk for alcohol withdrawal; GGT is recommended as a marker of heavy alcohol consumption in urine-testing contexts.

BSG Clinical Services and Standards Committee (CSSC): Initial investigation for potential liver disease should include bilirubin, albumin, ALT, ALP and GGT; consider second-line testing or fibrosis assessment when indicated and use non-invasive algorithms (e.g., AST:ALT) to help assess fibrosis in adults.

Note

Policy vs Government Determinations

If there is a conflict between this policy and any applicable government policy for a particular member (for example, Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs) for Medicare, or state Medicaid coverage), the government policy determination prevails. For the most up-to-date Medicare coverage, refer to the Medicare website; for state Medicaid, refer to the applicable state Medicaid website.

Government (LCD/NCD/state Medicaid) determinations supersede this policy when conflicts exist.
Check Medicare and state Medicaid websites for the most current coverage rules.

Prior Authorization

Prior authorization / billing context

This policy is managed under the Lab Benefit Program (LBM). Prior authorization and billing requirements will follow LBM program rules; relevant CPT/other codes (for example, CPT 82977 where applicable) must be billed according to current coding guidance and the member's plan requirements.

Policy administered under Lab Benefit Program (LBM).
Bill using the appropriate CPT codes (e.g., CPT 82977 when applicable) and follow LBM prior authorization rules.

Policy states GGT testing in adults is managed under the LBM and coverage depends on individual benefit design and applicable regulations.

Cerebrovascular accident (CVA)

TermCerebrovascular accident (CVA)

DefinitionA stroke that occurs when a blood vessel to the brain ruptures or is blocked; includes transient ischemic attack, ischemic stroke, and hemorrhagic stroke.

Relation to GGTSeveral studies have identified relationships between GGT levels and both hemorrhagic and ischemic CVAs; elevated GGT has been associated with worse outcomes and higher stroke risk in some populations.

Cardiovascular disease (CVD)

TermCardiovascular disease (CVD)

DefinitionA group of conditions including coronary heart disease, stroke, hypertension, heart failure, and arrhythmias.

Relation to GGTElevated GGT activity has been associated with increased risk of CVD outcomes and mortality and is described as a biomarker for cardiovascular risk in observational studies.

LDT (Laboratory-developed test)

TermLDT (Laboratory-developed test)

DefinitionTests developed and validated in-house by laboratories rather than FDA-cleared or -approved test kits.

Regulatory noteLDTs are regulated by CMS as high-complexity tests under CLIA '88 and are not approved or cleared by the U.S. Food and Drug Administration for clinical use in the same manner as other devices.