ModifiedEmblemHealthPolicy AHS-G2173

Gamma-glutamyl Transferase Testing in Adults - Lab Benefit Program (LBM)

This reimbursement policy governs coverage criteria and limitations for serum GGT testing in adults (age 18+) under the Lab Benefit Program; applicability depends on the individual's benefit coverage and state/federal regulations.

Policy Summary

PayerEmblemHealth

PolicyGamma-glutamyl Transferase Testing in Adults - Lab Benefit Program (LBM)

Policy CodePolicy AHS-G2173

Change TypeMaterial revisions and clarifications (including added malignant neoplasm language and scope updates)

Effective DateMar 1, 2023

Next Review DateN/A

Key ActionConfirm isolated alkaline phosphatase elevation with GGT and include GGT (plus albumin, bilirubin, PT/INR) when further evaluating abnormal liver screening tests.

SourceLink

POLICY UPDATE CHANGES

Addition of 'of the digestive system.' to Coverage Criteria 2.e., now reads: 'e) For individuals with primary or secondary malignant neoplasms of the digestive system.'

Coverage is limited to Gamma-glutamyl Transferase testing in adults and policy title changed to 'Gamma-glutamyl Transferase Testing in Adults'.

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

Removal of drug ingestion from Coverage Criterion (2.a.) and frequency change in Coverage Criterion 1 & 2.

18+Age group

every 2 weeksMax test frequency

excluded

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Coverage stance (wellness)

2/13/2026Latest revision

Coverage Criteria for GGT Testing in Adults

GGT testing coverage criteria (adults)

Coverage decisions depend on member benefits; applies to adults (18+).

Covered when ALL of the following are met:

ALL of the following

Individual is age 18 years or older.
Testing is ordered under the Lab Benefit Program (benefit-dependent).
Application of coverage criteria is dependent upon an individual's benefit coverage at the time of the request; see applicable Medicare/Medicaid rules.
ONE of
- Serum GGT testing to confirm hepatic origin when alkaline phosphatase activity is elevated.No more than once every two weeks
  GGT used to confirm liver source of isolated alkaline phosphatase elevation.
- ALL of the following
  - 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 causing hepatic injury.
  - Primary or secondary malignant neoplasms of the digestive system.
  - Diabetes mellitus.

EXCLUSION: Serum GGT testing during a wellness visit or general exam for asymptomatic individuals without abnormal findings does NOT meet coverage criteria.

Society-guided use of GGT

Clinical recommendations from professional societies regarding when to measure GGT:

Society guidance summary:

ONE of

American College of Gastroenterology (ACG): Repeat abnormal liver chemistries and/or perform a clarifying test (e.g., GGT if alkaline phosphatase is elevated) before initiating evaluation; do not use GGT as a screening test for liver disease in the absence of other abnormal liver chemistries.
Clinical Services and Standards Committee (BSG/CSSC): Initial investigation for potential liver disease should include bilirubin, albumin, ALT, ALP and GGT as part of first-line tests; consider second-line testing and fibrosis assessment where indicated.
Canadian Association of Gastroenterology (CAG): GGT may be used as a second-line biochemical test; all patients with at least one abnormal liver screening test (ALT, AST or ALP) should have GGT, albumin, bilirubin and PT/INR performed as part of further evaluation.

Primary coverage criteria (summary from revisions)

Coverage is specific to adults (18+) and governed by the Lab Benefit Program; recent revisions added specific malignant neoplasm language and removed certain prior restrictions.

Policy scope: Coverage limited to adults (individuals 18 years and older) under the Lab Benefit Program; CPT code referenced for GGT testing is 82977.

ALL of the following

Addition (effective 2/13/2026): Coverage Criterion 2.e amended to read 'primary or secondary malignant neoplasms of the digestive system.'
Prior revisions removed 'drug ingestion' from Coverage Criterion 2.a and adjusted testing frequency in Criteria 1 & 2.
LBM scope expanded to include EmblemHealth HMO/PPO (Non-City) Commercial, Medicare and Medicaid plans effective 10/1/2024.

Coding and Test Frequency

applicable CPT/HCPCSmixed

No codes listed

mixed

CPT codesCPTCovered

82977

Glutamyltransferase, gamma (GGT)

inv-07: maximum_test_frequency

Maximum testing intervalNo more than once every two weeks for covered indications

Applies toAdults (18 years of age or older)

Indication exampleIndividuals with elevated alkaline phosphatase activity

Repeatability noteCriterion repeatability tied to covered indications listed in policy (see coverage criteria)

inv-08: GGT variability risk stratification

Risk stratification methodSubjects stratified by quartiles of baseline GGT and GGT variability (average successive variability, ASV)

Provider Actions, Billing, and Confirmatory Testing

Note

Confirmatory testing recommendation

Confirmatory testing is recommended when alkaline phosphatase (ALP) is elevated in isolation. Per clinical guidance, measure GGT to confirm a hepatic origin for an isolated ALP elevation before pursuing liver‑directed imaging or other workup. GGT is not specific for liver disease and should not be used as a general screening test in the absence of other abnormal liver chemistries.

Confirm isolated ALP elevation with GGT or ALP fractionation
If ALP elevation occurs with other abnormal liver chemistries, additional confirmation with GGT is not required
Elevated GGT has limited specificity and can be seen with alcohol use, pancreatic disease, myocardial infarction, renal failure, emphysema, diabetes, and certain medications

Note

Second-line biochemical testing

GGT may be used as a second-line biochemical test as part of a broader liver biochemical panel. The Canadian Association of Gastroenterology (CAG) recommends that patients with at least one abnormal liver screening test (ALT, AST, or ALP) have GGT, albumin, bilirubin (including direct if total bilirubin is elevated) and either PT or INR performed. These tests may be performed initially if follow-up is impractical.

GGT considered a second-line biochemical test within a liver panel

Definitions and Abbreviations

inv-14: GGT definition

DefinitionGamma-glutamyl transferase (GGT), also known as gamma-glutamyl transpeptidase (GGTP), is a cell‑surface enzyme present in multiple tissues including liver, intestine, kidney, prostate, and pancreas; used as a marker for liver dysfunction, biliary disease, and alcohol consumption

Biologic roleCleaves extracellular glutathione and gamma‑glutamyl compounds to support intracellular glutathione synthesis and oxidative stress defense

Half-lifeReported half-life between 14 and 26 days

inv-15: AACC / ALP / LFT (examples)

AACCAmerican Association of Clinical Chemistry (abbreviation defined in policy)

ALPAlkaline phosphatase (abbreviation defined in policy)

Policy Summary

PayerEmblemHealth

PolicyGamma-glutamyl Transferase Testing in Adults - Lab Benefit Program (LBM)

Policy CodePolicy AHS-G2173

Change TypeMaterial revisions and clarifications (including added malignant neoplasm language and scope updates)

Effective DateMar 1, 2023

Next Review DateN/A

Key ActionConfirm isolated alkaline phosphatase elevation with GGT and include GGT (plus albumin, bilirubin, PT/INR) when further evaluating abnormal liver screening tests.

SourceLink

On This Page

Disorders of iron and mineral metabolism.

Gastrointestinal disease.

Assessment of liver function subsequent to liver transplantation.

title": "Society-guided use of GGT

Operational note: If federal or state government coverage (e.g., LCD/NCD or state Medicaid) conflicts with this policy, the government policy prevails.

High ASV associationHigher GGT ASV quartiles associated with increased risk of stroke, myocardial infarction, and mortality in diabetics

Cohort exampleLee et al. (2020): 698,937 diabetic patients >40 years assessed for GGT ASV over 5 years

Metabolic linksHigher GGT quartiles correlated with obesity, hypertension, dyslipidemia, and CKD in higher ASV quartiles

Order albumin, bilirubin (direct if indicated), and PT/INR alongside GGT when any liver screening test is abnormal

Billing Rule

Billing / coding reference (procedure code 82977)

Bill using CPT code 82977 for Glutamyltransferase, gamma (GGT). Ensure documentation supports the medical necessity (e.g., isolated ALP elevation or abnormal liver chemistries) to avoid claim denial or recoupment. Follow payer-specific billing edits and industry coding guidance (AMA CPT, NCCI, MUE) and applicable state/federal regulations.

CPT: 82977 — Glutamyltransferase, gamma (GGT)
Document clinical rationale: isolated ALP elevation or abnormal liver chemistries
Claims may be denied if coding/billing guidelines or payer-specific policies are not followed

LFTLiver function test (abbreviation defined in policy)

inv-16: Metabolic syndrome

DefinitionMetabolic syndrome: a cluster of conditions including high blood sugar, hypertension, obesity, and abnormal cholesterol levels; GGT identified as a biomarker for metabolic syndrome risk

EvidenceStudies report higher GGT levels in subjects with metabolic‑syndrome related disorders and increasing MetS prevalence across higher GGT quartiles

Associated outcomesMetabolic syndrome increases risk for heart disease, stroke, type 2 diabetes, and neurologic disorders

inv-17: CVA / stroke

DefinitionCerebrovascular accident (CVA)/stroke: interruption of blood flow to the brain; includes transient ischemic attack, ischemic stroke, and hemorrhagic stroke

GGT associationsElevated or variable serum GGT has been associated with increased risk of ischemic and hemorrhagic stroke and worse functional outcomes after aneurysm/stroke

Prognostic findingsGGT variability linked to higher risk of stroke in general population; higher serum GGT associated with increased mortality after acute ischemic stroke

inv-18: LDT (laboratory-developed tests)

DefinitionLaboratory‑developed tests (LDTs): tests developed and performed in‑house by laboratories and regulated under CLIA '88 as high‑complexity tests; not approved/cleared by the FDA for clinical use

Regulatory oversightLDTs are regulated by CMS under CLIA '88; FDA clearance/approval is not currently required for clinical use

ContextMany labs have developed specific GGT assays as LDTs which must be validated and performed in house