Laboratory - Folate Testing
Medicare Advantage payment policy governing reimbursement for laboratory folate tests (serum folate, RBC folate, and folate receptor autoantibody testing) for Humana Medicare Advantage members. It explains when serum folate is reimbursable and which folate-related assays are not reimbursable.
No material clinical or coverage changes in this revision.
Coverage Criteria for Folate Testing
Covered Indications for Serum Folate (82746)
Serum folate testing (CPT 82746) is reimbursable when ANY of the following are present:
From Medicare Advantage payment policy guidance
Megaloblastic or macrocytic anemia — serum folate (CPT 82746) reimbursable
Per Medicare Advantage payment policy
Folate deficiency — serum folate (CPT 82746) reimbursable
Per Medicare Advantage payment policy
Pre- or post-bariatric surgery patients — serum folate (CPT 82746) reimbursable
Per Medicare Advantage payment policy
Not Reimbursable — tests considered not reimbursable
The following tests are considered not reimbursable:
This policy excludes measurement of red blood cell (RBC) folate (CPT 82747) and folate receptor autoantibody testing (proprietary FRAT®, CPT 0399U) from reimbursement. These assays are not covered under the Humana Medicare Advantage folate testing policy and claims for these codes will not be reimbursed.
Coding and Reimbursement Status
| 82746 | Folic acid; serum |
| 82747 | Folic acid; RBC |
| 0399U | Neurology (cerebral folate deficiency), serum, detection of anti-human folate receptor IgG-binding antibody and blocking autoantibodies by enzyme-linked immunoassay (ELISA), qualitative, and blocking autoantibodies, using a functional blocking assay for IgG or IgM, quantitative, reported as positive or not detected (Proprietary test: FRAT®; Lab/Manufacturer: Religen Inc) |
Provider Actions and Documentation
Reimbursable indication for serum folate
Measurement of serum folate (CPT 82746) is reimbursable when medically indicated; documentation should clearly support one of the listed clinical diagnoses or situations.
- Reimbursable CPT: 82746 (Folic acid; serum)
- Indications: megaloblastic or macrocytic anemia; folate deficiency; history of or scheduled bariatric procedure
Clinical documentation for serum folate
Clinical documentation must support the medical necessity for serum folate testing. Acceptable documentation includes diagnosis codes and clinical notes indicating megaloblastic or macrocytic anemia, documented folate deficiency, or a history of or planned bariatric surgery.
- Include relevant diagnosis codes (e.g., megaloblastic anemia, folate deficiency) on the claim and in the medical record
- Document clinical findings or history that justify testing (CBC with macrocytosis, symptoms, prior bariatric procedure or scheduled bariatric surgery)
- Retain supporting lab and clinical notes in the medical record for audit
Denied tests
Certain folate-related tests are not reimbursable and will be denied if billed.
Ordering Requirements
ORDERING REQUIREMENTS: support orders with listed indications
Ordering of serum folate (CPT 82746) should be supported in the medical record by one of the policy’s listed clinical indications: megaloblastic/macrocytic anemia, folate deficiency, or pre-/post-bariatric procedure status.
Not Covered Services
Definitions
Background
Folate status may be assessed using serum folate or red blood cell (RBC) folate. Serum folate (CPT 82746) reflects recent folate intake and is the reimbursable test in this policy for evaluating individuals with megaloblastic or macrocytic anemia, documented folate deficiency, or those who have undergone or are scheduled for bariatric procedures. RBC folate reflects longer-term folate status but is excluded from reimbursement by this policy (CPT 82747).
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.