CurrentUnitedHealthcarePolicy CS021ID.B

Collagen Crosslinks and Biochemical Markers of Bone Turnover (for Idaho Only)

UnitedHealthcare medical policy applicable only to Idaho (including Idaho Medicaid Plus) that addresses coverage rationale, clinical evidence, and coding for serum or urine collagen crosslinks and biochemical bone turnover markers.

Policy Summary

PayerUnitedHealthcare

PolicyCollagen Crosslinks and Biochemical Markers of Bone Turnover (for Idaho Only)

Policy CodePolicy CS021ID.B

Change TypeSupporting information update (Clinical Evidence and References)

Effective DateJune 1, 2026

Next Review Date

Key ActionServices for serum or urine collagen crosslinks or biochemical markers of bone turnover are considered unproven and not medically necessary and are therefore not covered under this policy for Idaho members; verify applicable federal, state, or contractual requirements before using this policy.

SourceLink

POLICY UPDATE CHANGES

06/01/2026: Updated Clinical Evidence and References sections to reflect the most current information; archived previous policy version CS021ID.A.

1Referenced CPT code groups

Idaho-onlyGeographic scope

numerousReferences cited (recent through 2025)

1Policy history entries

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Coverage Summary

Bone turnover markers (BTMs) — biochemical markers of bone formation and resorption such as P1NP, CTX, pyridinoline, telopeptides, osteocalcin, and bone alkaline phosphatase — are measurable in serum or urine and have been investigated for fracture risk prediction, monitoring therapy, and guiding osteoporosis management (policy: Collagen Crosslinks and Biochemical Markers of Bone Turnover).

Scope: This UnitedHealthcare medical policy applies only to the state of Idaho (including Idaho Medicaid Plus). Policy statement headline: Serum or urine collagen crosslinks or biochemical markers are unproven and not medically necessary to assess risk of fracture, predict bone loss, or assess response to antiresorptive therapy. Policy number: CS021ID.B. Effective date: June 1, 2026.

Policy summary

Referenced CPT code groups1

Geographic scopeIdaho-only

References citednumerous (recent through 2025)

Policy history entries1

Policy numberCS021ID.B

SubjectCollagen crosslinks and biochemical markers of bone turnover

Medical Necessity / Coverage Rationale

Not Covered / Unproven Services

Not covered — UnitedHealthcare considers tests for serum or urine collagen crosslinks and other biochemical bone turnover markers to be unproven and not medically necessary for assessing fracture risk, predicting bone loss, or assessing response to antiresorptive therapy. The policy states these services are considered unproven and not medically necessary for the listed indications and are therefore not covered under this policy for Idaho members.

Rationale references: the policy notes clinical validity is unproven and that prospective, well-designed trials are needed to substantiate a role for BTMs in management; local contractual, federal, or state benefit requirements may govern in the event of a conflict and should be verified prior to application.

Denial Risk

Claims for collagen crosslinks/BTMs in Idaho

Services for serum or urine collagen crosslinks or biochemical markers of bone turnover are considered unproven and not medically necessary for assessing fracture risk, predicting bone loss, or assessing response to antiresorptive therapy and are therefore not covered under this policy for Idaho members.

82523
Applies to Idaho members

Coding

Applicable CPT codes (reference only)CPT

82523

Collagen cross links, any method

Documentation Required

Reference contractual/federal/state requirements; Use of third-party tools

Before using this policy, verify applicable federal, state, or contractual benefit plan requirements because they may differ and govern in the event of a conflict. UnitedHealthcare may use third-party tools (e.g., InterQual criteria) to assist in administering benefits; clinicians should apply independent professional judgment.

Background and Evidence

Bone turnover markers (BTMs) are biochemical measures of bone formation or resorption obtained from serum or urine (e.g., pyridinoline, telopeptides, N-telopeptide, osteocalcin, bone alkaline phosphatase). Although attractive for their ease of sampling and their use in research, clinical use is controversial because of the complexity of interpreting individual values and a lack of standardization across laboratories that results in unacceptable interlaboratory variation.

Evidence item	Summary
Overall evidence statement	Clinical validity is unproven; insufficient evidence from prospective well‑designed trials to support use for diagnosis, monitoring therapy response, or predicting fracture risk.
Notable systematic assessments	ECRI 2018 concluded there is insufficient evidence to determine whether BTMs are useful in diagnosing osteoporosis or monitoring response to treatment; studies report mixed results and are at risk of bias.
FDA consumer guidance	FDA consumer‑focused website on osteoporosis does not include biochemical markers in its list of diagnostic tests (accessed Sept 11, 2024); no FDA‑identified use of BTMs for diagnosis or drug selection/dosing.
Recent guideline/meta-analysis citations	Multiple recent guidance and reviews (2019–2025) note PINP and β‑CTX as reference markers and discuss limited clinical utility; ESCEO/IOF/IFCC 2025 reaffirm PINP and β‑CTX for monitoring therapy, while other societies (Endocrine Society, ISCD/IOF, BHOF, NAMS, Osteoporosis Canada) provide varied recommendations reflecting inconclusive evidence for routine clinical use.

Definitions

TermBTMs

DefinitionBiochemical markers of bone turnover (bone formation and bone resorption markers) measured in serum or urine.

Revision History

06/01/2026revisedLatest

06/01/2026: Updated Clinical Evidence and References sections to reflect the most current information; archived previous policy version CS021ID.A.