CurrentHumanaPolicy LAB2023040

Laboratory - Diagnosis of Idiopathic Environmental Intolerance

Policy describes Humana Medicare Advantage claims payment stance on laboratory testing used in the evaluation of idiopathic environmental intolerance and specifies tests that are not reimbursable at general wellness exams; it applies to providers submitting claims for Humana Medicare Advantage members.

Policy Summary

PayerHumana

PolicyLaboratory - Diagnosis of Idiopathic Environmental Intolerance

Policy CodePolicy LAB2023040

Change TypeNo material change

Effective DateJul 1, 2023

Next Review Date

Key ActionEnsure claims for listed laboratory tests performed at a general wellness exam are not submitted for reimbursement for Humana Medicare Advantage members.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Numerouslaboratory tests excluded at general wellness exams

Medicare Advantageplan applicability

Jul 2023document dates

Multiplelinks to Original Medicare LCDs

Coverage Criteria

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.

Non-reimbursable tests at general wellness exams

At a general wellness exam, the following laboratory tests are not reimbursable:

At a general wellness exam, testing for chlorinated pesticides (CPT code 82441), including DDE and DDT, using blood, serum, plasma, saliva, urine or stool sample is not reimbursable.

For individuals over age 4

5-hydroxyindolacetic acid (5-HIAA) (CPT code 83497)
Amino acids (CPT code 82127, CPT code 82136, CPT code 82139)
Allergen-specific immunoglobulin G (IgG) (CPT code 86001)
Behenic acid (CPT code 82542)
Carotene or beta-carotene (CPT code 82380)
Carnitine (CPT code 82379)
Citrate (CPT code 82507)
Elastase (CPT code 82653, CPT code 82656)
Fat stain (CPT code 89125)
Gastrointestinal fat absorption study (HCPCS code S3708)
Glutathione (CPT code 82978)
Homovanillic acid (HVA) (CPT code 83150)
Lignoceric acid (CPT code 82542)
Lipid peroxides (CPT code 82542)
Prealbumin (CPT code 84134)
Qualitative or quantitative fat differentiation testing (CPT code 82705, CPT code 82710, CPT code 82715)
Vanillylmandelic acid (VMA) testing (CPT code 84585)

Also not reimbursable at a general wellness exam (samples: blood, serum, urine, cerebrospinal fluid, fingernails, hair or stool)

Cadmium (CPT code 82300)
Chromium (CPT code 82495)
Copper (CPT code 82525)
Heavy metal (CPT code 83015, CPT code 83018)
Magnesium (CPT code 83735)
Manganese (CPT code 83785)
Nickel (CPT code 83885)

Coding and Age Restrictions

Examples of codes named in policyCPTNot Covered

82127	Amino acids; single, qualitative, each specimen.
82136	Amino acids, 2 to 5 amino acids, quantitative, each specimen.
82139	Amino acids, 6 or more amino acids, quantitative, each specimen.
82300	Cadmium.
82441	Chlorinated hydrocarbons, screen.
82495	Chromium.
82525	Copper.
83015	Heavy metal (e.g., arsenic, barium, beryllium, bismuth, antimony, mercury); qualitative, any number of analytes.
83018	Heavy metal (e.g., arsenic, barium, beryllium, bismuth, antimony, mercury); quantitative, each, not elsewhere specified.
83735	Magnesium.

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Age-specific restriction at general wellness exam

RestrictionFor individuals over age 4, specified tests listed in this policy are not reimbursable when performed at a general wellness exam.

Applicable sample typesBlood, serum, plasma, saliva, urine or stool samples (tests performed on these specimens at a general wellness exam are not reimbursable).

ScopeApplies to Medicare Advantage members as part of Humana's payment policy guidance for these laboratory tests.

Provider Actions and Requirements

Prior Authorization

Authorization and plan requirements

Claims payments are subject to medical necessity, reasonableness, and any applicable referral or authorization requirements. When Original Medicare Local Coverage Determinations (LCDs) have established criteria for a procedure, those LCDs take precedence and may govern coverage for Medicare Advantage members.

Definitions

Medicare Advantage Payment Policy

DefinitionMedicare Advantage Payment Policy: Humana’s policy framework that explains coverage and payment criteria applicable to Medicare Advantage plans; subject to Original Medicare LCDs when established.

ApplicationCriteria apply to Medicare Advantage plans except when Original Medicare Local Coverage Determinations (LCDs) govern the procedure.

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

General wellness exam

DefinitionGeneral wellness exam: the preventive encounter context in which the policy specifies certain laboratory tests are not reimbursable.

Examples in policyThe policy lists numerous specific tests (e.g., 5-HIAA, amino acid panels, allergen-specific IgG, various fatty acid and heavy metal tests) that are not reimbursable when performed at a general wellness exam.

Specimen contextsProhibitions at a general wellness exam include tests on blood, serum, plasma, saliva, urine, stool (and for some tests additional specimen types such as CSF, fingernails, hair are referenced elsewhere in the policy).