Laboratory - Testing for Alpha‑1 Antitrypsin (A1AT) Deficiency
Defines Humana Medicare Advantage payment policy for serum A1AT quantification and A1AT phenotyping (CPT 82103, 82104), specifying clinical indications under which these tests are reimbursable and noting applicability to Medicare Advantage products.
No material clinical or coverage changes in this revision.
Coverage Criteria for A1AT Testing
Reimbursable indications
Covered when ANY one of the following clinical indications is present:
Applies to CPT 82103 and 82104 for Medicare Advantage plans.
Tests for CPT 82103 (serum quantification of alpha-1 antitrypsin) and CPT 82104 (A1AT phenotyping) are reimbursable for Medicare Advantage members only when one of the following clinical indications is present: individuals with emphysema, COPD, chronic bronchitis, bronchiectasis, or asthma; individuals with liver disease; individuals with necrotizing panniculitis; individuals with vasculitis; individuals with neonatal cholestasis; or a family history of alpha-1 antitrypsin deficiency or related genetic, blood, endocrine, nutritional, or metabolic disease.
Specific Indications That Qualify for Coverage
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