CurrentHumanaPolicy LAB2023036

Intracellular Micronutrient Analysis - Payment Policy

Humana's payment policy for intracellular micronutrient laboratory analyses governing reimbursement guidance for Medicare Advantage and Commercial products; intended for health care providers submitting claims for these tests.

Policy Summary

PayerHumana

PolicyIntracellular Micronutrient Analysis - Payment Policy

Policy CodePolicy LAB2023036

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionSubmit claims that meet medical necessity, reasonableness, and any applicable referral or authorization requirements.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

06/2023published date

11/2024revision date

Medicare Advantage & Commercialapplicable product lines

27+procedure codes referenced

Coverage Criteria

Coverage criteria overview

General coverage posture and how this policy interacts with Original Medicare NCDs/LCDs and plan claim requirements.

Commercial payment policy criteria apply to Medicare Advantage plans unless a procedure has established criteria through Original Medicare National Coverage Determinations (NCDs) or Local Coverage Determinations (LCDs).

Claims remain subject to other plan requirements, including medical necessity, reasonableness, and any applicable referral or authorization requirements.

Some tests are explicitly not reimbursable for diagnosing a nutritional disorder or as part of a general wellness exam.

Specific procedure codes referenced in this policy may be subject to Medicare contractor–specific LCDs or jurisdictional exceptions; see listed Original Medicare LCDs for applicable codes (examples include 82495, 82525, 83785, 84255, 84630, 82652, 83735, 82180, 82379, 82607, 82746, 84207, 84252, 84425, 84446, 84590, 84597).

Policy Summary

PayerHumana

PolicyIntracellular Micronutrient Analysis - Payment Policy

Policy CodePolicy LAB2023036

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionSubmit claims that meet medical necessity, reasonableness, and any applicable referral or authorization requirements.

SourceLink

On This Page

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.

Coding and Procedure Codes

Referenced procedure codesCPT

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

1–10 of 23

1/3

Medicare jurisdiction exceptions

Jurisdiction-specific applicabilityCertain procedure codes have payment criteria that apply to all Medicare jurisdictions except the states awarded to specific Medicare contractors (see listed exceptions).

Codes with Novitas exceptionAll listed applicable procedures apply to all Medicare jurisdictions, except those states awarded to Novitas Solutions, Inc.

Codes with National Government Services exceptionPayment criteria for 82495, 82525, 83785, 84255, and 84630 apply to all Medicare jurisdictions except those states awarded to National Government Services, Inc.

Codes with multiple-contractor exceptionsProcedure code 82652 payment criteria apply to all jurisdictions except those states awarded to National Government Services, Inc.; Noridian Healthcare Solutions, LLC; Novitas Solutions, Inc.; Palmetto GBA; and WPS Insurance Corporation.

Codes with Noridian/Palmetto exceptionsProcedure code 83735 payment criteria apply to all jurisdictions except those states awarded to Noridian Healthcare Solutions, LLC and Palmetto GBA.

Provider Action Requirements

Prior Authorization

Preauthorization / claim requirements

In addition to the policy, claims payments are subject to plan requirements for processing and payment of claims, including but not limited to medical necessity, reasonableness, and any applicable referral or authorization requirements.

Claims are subject to medical necessity and reasonableness determinations
Applicable referral or prior authorization requirements must be met before services are rendered

Denial Risk

Non-reimbursable uses

The following tests are NOT reimbursable when used to diagnose a nutritional disorder or when performed as part of a general wellness exam.

Tests performed solely for general wellness screening without clinical indication are not covered
Tests used only to diagnose nutritional disorders are not reimbursable under this policy

Definitions and Policy Scope

Medicare Advantage Payment Policy

General rule for Medicare AdvantageMedicare Advantage follows the Commercial Payment Policy criteria except when a procedure has established criteria via Original Medicare NCDs or LCDs.

Claims requirementsClaims remain subject to plan requirements including medical necessity, reasonableness, and any applicable referral or authorization requirements.

Interaction with Original Medicare determinationsWhen an Original Medicare NCD or LCD establishes coverage criteria for a procedure, that determination supersedes the Commercial criteria for Medicare Advantage.

Applicable procedure codes

Amino acids (multiple, qualitative)CPT 82128 - Amino acids; multiple, qualitative, each specimen

Amino acids (2–5, quantitative)CPT 82136 - Amino acids, 2 to 5 amino acids, quantitative, each specimen

Vitamin C (ascorbic acid)CPT 82180 - Ascorbic acid (vitamin C), blood

CarnitineCPT 82379 - Carnitine (total and free), quantitative each specimen

ChromiumCPT 82495 - Chromium

CopperCPT 82525 - Copper

Vitamin B-12CPT 82607 - Cyanocobalamin (Vitamin B-12)

Vitamin D (1,25 dihydroxy)CPT 82652 - Vitamin D; 1,25 dihydroxy, includes fraction(s) if performed

Fatty acids (nonesterified)CPT 82725 - Fatty acids, nonesterified

Folic acidCPT 82746 - Folic acid; serum

GlutathioneCPT 82978 - Glutathione

MagnesiumCPT 83735 - Magnesium

ManganeseCPT 83785 - Manganese

Pyridoxal phosphate (B-6)CPT 84207 - Pyridoxal phosphate (vitamin B-6)

Riboflavin (B-2)CPT 84252 - Riboflavin (vitamin B-2)

SeleniumCPT 84255 - Selenium

Thiamine (B-1)CPT 84425 - Thiamine (vitamin B-1)

Vitamin E (tocopherol alpha)CPT 84446 - Tocopherol alpha (Vitamin E)

Vitamin ACPT 84590 - Vitamin A

Vitamin NOSCPT 84591 - Vitamin not otherwise specified

Vitamin KCPT 84597 - Vitamin K

ZincCPT 84630 - Zinc

Electron microscopyCPT 88348 - Electron microscopy diagnostic