ModifiedEmblemHealthPolicy AHS-G2120

Salivary Hormone Testing Lab Benefit Program (LBM)

This reimbursement policy governs coverage criteria for salivary hormone testing (including late-night salivary cortisol and broader salivary steroid panels) for EmblemHealth members and specifies indications that meet or do not meet coverage. It applies to claims and billing for covered products under the payer's plans.

Policy Summary

PayerEmblemHealth

PolicySalivary Hormone Testing Lab Benefit Program (LBM)

Policy CodePolicy AHS-G2120

Change TypeCode removalsLBM plan expansiontemplate update

Effective DateMar 1, 2023

Next Review DateN/A

Key ActionFor individuals with signs and symptoms of Cushing syndrome, late-night salivary cortisol testing meets coverage criteria; verify member benefit and bill under the Lab Benefit Program using applicable CPT/HCPCS codes.

SourceLink

POLICY UPDATE CHANGES

Removed CPT codes 82626, 82627, 82670, 82671, 82672, 82677, 82679, 82681, 84144, 84402, 84403, & 84410 from Applicable CPT/HCPCS Procedure Codes table effective 8/13/2025.

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

Transferred policy content to individual company-branded template.

LNSCLNSC role

Does not meet coverageNot covered for many indications

Variable accuracyAnalytical limitations

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Example procedure codes

2.4 nmol/LPediatric cutoff noted

Coverage Criteria for Salivary Hormone Testing

inv-01: Coverage criteria — coverage stance for specific clinical indications and limits

Covered when ALL of the following are met:

ALL of the following

Not covered for the following indications
- menopause
- infertility
- endometriosis
- polycystic ovary syndrome (PCOS)
- premenstrual syndrome (PMS)
- osteoporosis
- seasonal affective disorder
- depression
- multiple sclerosis
- sleep disorders
- diseases related to aging

inv-02: Coverage context and operational criteria — clinical and policy context informing coverage decisions

Context and operational notes that inform application of coverage criteria:

Multiple specialty society position statements note that salivary hormone assays are not standardized, have variable accuracy, and lack sufficient evidence to guide individualized hormone therapy; these endorsements are cited in the policy and inform the noncoverage stance for many indications.

Salivary assays may be performed as laboratory-developed tests (LDTs) under CLIA and are not necessarily FDA-approved; this affects interpretation of analytic validity and quality control expectations.

Application of coverage criteria depends on an individual member's benefit coverage at the time of the request; providers should verify applicable plan benefits and prior authorization requirements.

For Cushing syndrome evaluation, LNSC is recognized in the policy as a first-line biochemical test and may be used to suggest the presence or recurrence of hypercortisolism; the Endocrine Society recommends obtaining at least two late-night salivary cortisol measurements for diagnosis of Cushing syndrome.

Coding Guidance and Applicable Procedure Codes

Coding guidance and editsmixed

No codes listed

Applicable procedure codes (examples)CPT | HCPCS

82530	Cortisol, free (salivary)
82533	Cortisol; total
S3650	Saliva test; hormone level; during menopause
0462U	Melatonin levels test; saliva (proprietary Salimetrics test)

LNSC diagnostic thresholds referenced

Pediatric bedtime cutoffBedtime salivary cortisol cutoff 2.4 nmol/L reported for children (Ueland et al.; verification cohort).

Study-range cutoffsStudies report diagnostic cutoffs for LNSC in screening ranging approximately 2.4–4.0 nmol/L depending on assay and cohort (multiple studies cited).

Overt Cushing threshold in one RIA reportA locally modified RIA study reported a threshold of 12 nmol/L yielded 100% sensitivity and specificity in overt Cushing syndrome.

Effective date for removed CPT codes

Effective date for removed CPT codesRemoved CPT codes (list) effective 8/13/2025 per revision history.

Revision reference

Provider Actions, Billing & Prior Authorization

Prior Authorization

Prior authorization and coverage depend on individual benefit

Late-night salivary cortisol testing meets coverage criteria for individuals with signs and symptoms of Cushing syndrome; whether authorization is required or covered depends on the member's individual benefit at the time of the request.

Confirm member benefit coverage and any prior authorization requirements before ordering LNSC.
Document clinical signs or symptoms suggestive of Cushing syndrome to support medical necessity.

Billing Rule

Bill under LBM and follow revised procedure code list

Claims for salivary hormone testing must follow the Lab Benefit Program (LBM) reimbursement policy and be billed using the applicable CPT/HCPCS procedure codes listed in the policy; note that the policy's applicable code list was revised and several CPT codes were removed effective 8/13/2025 and LBM plan applicability was expanded effective 10/1/2024.

Definitions and Abbreviations

LNSC — Late-night salivary cortisol definition

DefinitionLate-night salivary cortisol (LNSC): measurement of free cortisol in saliva collected at late-night/bedtime as a screening test for Cushing syndrome.

Clinical roleUsed as a frontline screening test for Cushing syndrome in many studies, showing high concordance with 24‑hour urinary cortisol and strong sensitivity/specificity at reported cutoffs.

Analytic considerationsAssay-dependent thresholds and variable standardization across methods; cortisone may be measured alongside cortisol due to assay interference.

LC-MS-MS — analytic method definition

DefinitionLC‑MS/MS (liquid chromatography with tandem mass spectrometry): an analytic method used for salivary cortisol/cortisone measurement that provides improved specificity over some immunoassays.

Use in studies

Policy Summary

PayerEmblemHealth

PolicySalivary Hormone Testing Lab Benefit Program (LBM)

Policy CodePolicy AHS-G2120

Change TypeCode removalsLBM plan expansiontemplate update

Effective DateMar 1, 2023

Next Review DateN/A

SourceLink

On This Page

Claims for salivary hormone testing must follow the Lab Benefit Program (LBM) reimbursement rules and applicable CPT/HCPCS coding listed in the policy; the policy's revision history and applicable code list should be consulted for current billable codes and any removed codes.

Revision recorded April 2025 in policy revision history noting code removals.

Action for billingProviders should not bill using the removed CPT codes after 8/13/2025 and must use the remaining applicable codes in the policy.

Use only the applicable CPT/HCPCS codes retained in the policy when submitting claims (see policy code table).
Be aware that CPT codes 82626, 82627, 82670, 82671, 82672, 82677, 82679, 82681, 84144, 84402, 84403, and 84410 were removed effective 8/13/2025.
LBM was expanded to include EmblemHealth HMO/PPO (Non-City) Commercial, Medicare and Medicaid plans effective 10/1/2024 — confirm plan applicability.

Referenced studies used LC‑MS/MS to set pediatric bedtime cutoffs and verify analytical validity of LNSC.

Analytic advantagesLC‑MS/MS reduces interference from cortisone and increases accuracy compared with some immunoassays, but standardization remains limited.

LDTs — laboratory-developed tests definition

DefinitionLaboratory-developed tests (LDTs): tests developed and validated in-house by laboratories (regulated by CMS under CLIA as high-complexity tests).

Regulatory noteLDTs are not approved or cleared by the U.S. Food and Drug Administration but may be used clinically when validated under CLIA requirements.

ImplicationMany salivary hormone assays are offered as LDTs, contributing to variability in methods and cutoffs across laboratories.

LDT — alternate LDT mention

Alternate LDT mentionSome salivary hormone tests are explicitly performed as LDTs and must be validated in‑house under CLIA '88; FDA clearance is not currently required for clinical use.

Overlap with definitionsThe policy notes LDT terminology and regulation alongside definitions for LC‑MS and LNSC, reflecting overlapping analytic and regulatory considerations.

Operational impactBecause many assays are LDTs, thresholds and analytic performance can differ by laboratory, affecting interpretation and billing under the Lab Benefit Program.