Testing for Alpha-1 Antitrypsin Deficiency
Defines Humana Medicare Advantage coverage and payment criteria for laboratory testing for alpha-1 antitrypsin (A1AT) deficiency, including serum quantification and phenotyping, and specifies clinical indications under which these tests are reimbursable for members.
No material clinical or coverage changes in this revision.
Coverage Criteria for A1AT Testing
Reimbursable Indications for A1AT Testing (CPT 82103, 82104)
Covered when ANY of the following clinical indications are present:
CPT codes 82103 and 82104 are reimbursable ONLY when one or more of these indications are met.
Testing for alpha-1 antitrypsin using CPT 82103 (A1AT quantification) and CPT 82104 (A1AT phenotyping) is reimbursable by Humana Medicare Advantage only when one or more of the specified clinical indications are present. The acceptable indications include respiratory disease (emphysema, COPD, chronic bronchitis, bronchiectasis, or asthma), liver disease, necrotizing panniculitis, vasculitis, neonatal cholestasis, or a relevant family history of AAT deficiency or related genetic/endocrine/metabolic/blood disorders. Claims lacking documentation that the member meets at least one of these indications may not be paid.
Clinical Indications That Qualify for Coverage
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