CurrentHumanaPolicy LAB2023036

Laboratory - Intracellular Micronutrient Analysis

Humana payment policy governing reimbursement for laboratory intracellular micronutrient analyses for Medicare Advantage and Commercial products; describes applicable procedure codes and applicability with respect to Medicare NCDs/LCDs and jurisdictions.

Policy Summary

PayerHumana

PolicyLaboratory - Intracellular Micronutrient Analysis

Policy CodePolicy LAB2023036

Change TypeNo material changes

Effective Date06/2023

Next Review Date

Key ActionEnsure claims meet plan requirements including medical necessity, reasonableness, and any applicable referral or authorization rules before submission.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

06/2023published

11/2024last review

Multiple (~30)procedure codes

Coverage Criteria and Applicability

Coverage criteria and jurisdictional applicability

Payment criteria and applicability for the laboratory tests listed below. Medicare Advantage follows the Commercial Payment Policy except where Original Medicare NCDs/LCDs establish coverage criteria for specific procedure codes. Claims are subject to plan requirements including medical necessity and applicable referral/authorization rules.

Tests listed are subject to the policy and payment criteria below; claims remain subject to medical necessity, reasonableness, and applicable referral or authorization requirements.

The following tests are NOT reimbursable for diagnosing a nutritional disorder or as part of a general wellness exam.

Enumerated CPT procedure codes are subject to this policy for Medicare Advantage and Commercial products.

Jurisdictional applicability

Policy Summary

PayerHumana

PolicyLaboratory - Intracellular Micronutrient Analysis

Policy CodePolicy LAB2023036

Change TypeNo material changes

Effective Date06/2023

Next Review Date

Key ActionEnsure claims meet plan requirements including medical necessity, reasonableness, and any applicable referral or authorization rules before submission.

SourceLink

On This Page

Applicable Procedure Codes

Applicable procedure codes (laboratory micronutrient assays)CPT

82128	Amino acids; multiple, qualitative, each specimen.
82136	Amino acids, 2 to 5 amino acids, quantitative, each specimen.
82180	Ascorbic acid (vitamin c), blood.
82379	Carnitine (total and free), quantitative each specimen.
82495	Chromium.
82525	Copper.
82607	Cyanocobalamin (Vitamin B-12).
82652	Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed.
82725	Fatty acids, nonesterified.
82746	Folic acid; serum.

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Claims, Payment Requirements, and Provider Notices

Prior Authorization

Claims/payment requirements and applicability

Claims payments are processed under plan requirements; providers must meet medical necessity and reasonableness standards and follow any applicable referral or authorization requirements. Medicare Advantage follows the Commercial Payment Policy except where Original Medicare NCDs/LCDs apply.

Ensure services meet medical necessity and reasonableness prior to billing.
Obtain and document any required referrals or prior authorizations per the member's plan.
For Medicare Advantage members, apply Commercial policy criteria unless an Original Medicare NCD/LCD provides established criteria for the procedure.

Billing Rule

Non-reimbursable uses — nutritional disorders and wellness exams

The listed intracellular micronutrient tests are not reimbursable when used to diagnose a nutritional disorder or when performed as part of a general wellness exam.

Do not bill these tests for screening or general wellness purposes.
Do not submit claims for diagnosing nutritional disorders using the listed tests under this policy.

Definitions and Plan Scope

Medicare Advantage

Policy scopeApplies to Humana Medicare Advantage plans; Commercial policy criteria apply to Medicare Advantage unless an Original Medicare NCD or LCD establishes different criteria.

Claims payment requirementsPayments remain subject to plan requirements including medical necessity, reasonableness, and applicable referral or authorization rules.

Relation to Original Medicare determinationsWhen procedures have established criteria via Original Medicare NCDs or LCDs, those determinations supersede the Commercial criteria for Medicare Advantage jurisdictions.

Intended use of policyGuideline for Humana claims payment processing; does not guarantee coverage, pre-authorization, or payment for individual members.

Effective/revision datesPublished 06/2023; Revision/last review 11/2024 (Policy number LAB2023036).