Laboratory - Pancreatic Enzyme Testing for Acute Pancreatitis
Defines Humana Medicare Advantage payment rules for laboratory measurement of pancreatic enzymes (lipase, amylase, trypsin/TAP) and related biomarkers when used in the evaluation of suspected acute pancreatitis; intended for providers submitting claims for Medicare Advantage members.
No material clinical or coverage changes in this revision.
Coverage criteria for pancreatic enzyme testing
Coverage criteria for pancreatic enzyme testing
Covered when ALL of the following are met:
ALL of the following
Clinical presentation
- Measurement of serum lipase (CPT 83690) OR serum amylase (CPT 82150) for the initial diagnosis of acute pancreatitis when the individual presents with one or more of the following signs or symptoms: abdominal distention, abdominal pain, abnormal weight loss, acute pancreatitis, anorexia, Cullen sign, diarrhea, fever, Grey Turner sign, hypoactive bowel sounds, hypotension, hypoxemia, ileus, nausea or vomiting, tachycardia, tachypnea.
- Measurement of either serum lipase (CPT 83690) or serum amylase (CPT 82150) is performed as the initial diagnostic test (not for routine/asymptomatic screening).
- Frequency limitation: Measurement of either serum lipase or amylase is not reimbursable more than once per week.
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