Thyroid Testing Including TSH National Coverage Determination

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Thyroid Testing Including TSHNational Coverage DeterminationCPT Codes:CodeDescription84436Thyroxine; total84439Thyroxine; free84443Thyroid stimulating hormone (TSH)84479Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR)CodeDescriptionA18.81Tuberculosis of thyroid glandC56.1Malignant neoplasm of right ovaryC56.2Malignant neoplasm of left ovaryC56.9Malignant neoplasm of unspecified ovaryC73Malignant neoplasm of thyroid glandC75.8Malignant neoplasm with pluriglandular involvement, unspecifiedC79.89Secondary malignant neoplasm of other specified sitesC79.9Secondary malignant neoplasm of unspecified siteD09.3Carcinoma in situ of thyroid and other endocrine glandsD09.8Carcinoma in situ of other specified sitesD27.0Benign neoplasm of right ovaryD27.1Benign neoplasm of left ovaryD27.9Benign neoplasm of unspecified ovaryD34Benign neoplasm of thyroid glandD35.2Benign neoplasm of pituitary glandD35.3Benign neoplasm of craniopharyngeal ductD44.0Neoplasm of uncertain behavior of thyroid glandD44.2Neoplasm of uncertain behavior of parathyroid glandD44.9Neoplasm of uncertain behavior of unspecified endocrine glandD49.7Neoplasm of unspecified behavior of endocrine glands and other parts of nervous systemD51.0Vitamin B12 deficiency anemia due to intrinsic factor deficiencyD53.9Nutritional anemia, unspecifiedD59.0Drug-induced autoimmune hemolytic anemiaD59.1Other autoimmune hemolytic anemiasD64.9Anemia, unspecifiedD89.82Autoimmune lymphoproliferative syndrome [ALPS]D89.89Other specified disorders involving the immune mechanism, not elsewhere classifiedE00.0Congenital iodine-deficiency syndrome, neurological typeE00.1Congenital iodine-deficiency syndrome, myxedematous typeE00.2Congenital iodine-deficiency syndrome, mixed typeE00.9Congenital iodine-deficiency syndrome, unspecifiedE01.0Iodine-deficiency related diffuse (endemic) goiterE01.1Iodine-deficiency related multinodular (endemic) goiterE01.2Iodine-deficiency related (endemic) goiter, unspecifiedE01.8Other iodine-deficiency related thyroid disorders and allied conditionsE02Subclinical iodine-deficiency hypothyroidismE03.0Congenital hypothyroidism with diffuse goiterE03.1Congenital hypothyroidism without goiterMedicare Limited Coverage Tests – Covered Diagnosis CodesSource: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) July 2015Effective October 1, 2015Medicare Limited Coverage Tests

Thyroid Testing Including TSHNational Coverage DeterminationCodeDescriptionE03.2Hypothyroidism due to medicaments and other exogenous substancesE03.3Postinfectious hypothyroidismE03.4Atrophy of thyroid (acquired)E03.5Myxedema comaE03.8Other specified hypothyroidismE03.9Hypothyroidism, unspecifiedE04.0Nontoxic diffuse goiterE04.1Nontoxic single thyroid noduleE04.2Nontoxic multinodular goiterE04.8Other specified nontoxic goiterE04.9Nontoxic goiter, unspecifiedE05.00Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or stormE05.01Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or stormE05.10Thyrotoxicosis with toxic single thyroid nodule without thyrotoxic crisis or stormE05.11Thyrotoxicosis with toxic single thyroid nodule with thyrotoxic crisis or stormE05.20Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or stormE05.21Thyrotoxicosis with toxic multinodular goiter with thyrotoxic crisis or stormE05.30Thyrotoxicosis from ectopic thyroid tissue without thyrotoxic crisis or stormE05.31Thyrotoxicosis from ectopic thyroid tissue with thyrotoxic crisis or stormE05.40Thyrotoxicosis factitia without thyrotoxic crisis or stormE05.41Thyrotoxicosis factitia with thyrotoxic crisis or stormE05.80Other thyrotoxicosis without thyrotoxic crisis or stormE05.81Other thyrotoxicosis with thyrotoxic crisis or stormE05.90Thyrotoxicosis, unspecified without thyrotoxic crisis or stormE05.91Thyrotoxicosis, unspecified with thyrotoxic crisis or stormE06.0Acute thyroiditisE06.1Subacute thyroiditisE06.2Chronic thyroiditis with transient thyrotoxicosisE06.3Autoimmune thyroiditisE06.4Drug-induced thyroiditisE06.5Other chronic thyroiditisE06.9Thyroiditis, unspecifiedE07.0Hypersecretion of calcitoninE07.1Dyshormogenetic goiterE07.89Other specified disorders of thyroidE07.9Disorder of thyroid, unspecifiedE08.00Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotichyperglycemic-hyperosmolar coma (NKHHC)E08.01Diabetes mellitus due to underlying condition with hyperosmolarity with comaE08.10Diabetes mellitus due to underlying condition with ketoacidosis without comaE08.11Diabetes mellitus due to underlying condition with ketoacidosis with comaE08.21Diabetes mellitus due to underlying condition with diabetic nephropathyE08.22Diabetes mellitus due to underlying condition with diabetic chronic kidney diseaseE08.29Diabetes mellitus due to underlying condition with other diabetic kidney complicationE08.311Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macularedemaE08.319Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy withoutmacular edemaE08.321Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy withmacular edemaMedicare Limited Coverage Tests – Covered Diagnosis CodesSource: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) July 2015Effective October 1, 2015Medicare Limited Coverage Tests

Thyroid Testing Including TSHNational Coverage DeterminationCodeDescriptionE08.329Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathywithout macular edemaE08.331Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathywith macular edemaE08.339Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathywithout macular edemaE08.341Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathywith macular edemaE08.349Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathywithout macular edemaE08.351Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macularedemaE08.359Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy withoutmacular edemaE08.36Diabetes mellitus due to underlying condition with diabetic cataractE08.39Diabetes mellitus due to underlying condition with other diabetic ophthalmic complicationE08.40Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecifiedE08.41Diabetes mellitus due to underlying condition with diabetic mononeuropathyE08.42Diabetes mellitus due to underlying condition with diabetic polyneuropathyE08.43Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathyE08.44Diabetes mellitus due to underlying condition with diabetic amyotrophyE08.49Diabetes mellitus due to underlying condition with other diabetic neurological complicationE08.51Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy withoutgangreneE08.52Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangreneE08.59Diabetes mellitus due to underlying condition with other circulatory complicationsE08.610Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathyE08.618Diabetes mellitus due to underlying condition with other diabetic arthropathyE08.620Diabetes mellitus due to underlying condition with diabetic dermatitisE08.621Diabetes mellitus due to underlying condition with foot ulcerE08.622Diabetes mellitus due to underlying condition with other skin ulcerE08.628Diabetes mellitus due to underlying condition with other skin complicationsE08.630Diabetes mellitus due to underlying condition with periodontal diseaseE08.638Diabetes mellitus due to underlying condition with other oral complicationsE08.641Diabetes mellitus due to underlying condition with hypoglycemia with comaE08.649Diabetes mellitus due to underlying condition with hypoglycemia without comaE08.65Diabetes mellitus due to underlying condition with hyperglycemiaE08.69Diabetes mellitus due to underlying condition with other specified complicationE08.8Diabetes mellitus due to underlying condition with unspecified complicationsE08.9Diabetes mellitus due to underlying condition without complicationsE09.00Drug or chemical induced diabetes mellitus with hyperosmolarity without nonketotichyperglycemic- hyperosmolar coma (NKHHC)E09.01Drug or chemical induced diabetes mellitus with hyperosmolarity with comaE09.10Drug or chemical induced diabetes mellitus with ketoacidosis without comaE09.11Drug or chemical induced diabetes mellitus with ketoacidosis with comaE09.21Drug or chemical induced diabetes mellitus with diabetic nephropathyE09.22Drug or chemical induced diabetes mellitus with diabetic chronic kidney diseaseE09.29Drug or chemical induced diabetes mellitus with other diabetic kidney complicationE09.311Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macularedemaE09.319Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macularedemaMedicare Limited Coverage Tests – Covered Diagnosis CodesSource: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) July 2015Effective October 1, 2015Medicare Limited Coverage Tests

Thyroid Testing Including TSHNational Coverage DeterminationCodeDescriptionE09.321Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy withmacular edemaE09.329Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy withoutmacular edemaE09.331Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathywith macular edemaE09.339Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathywithout macular edemaE09.341Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy withmacular edemaE09.349Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathywithout macular edemaE09.351Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macularedemaE09.359Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macularedemaE09.36Drug or chemical induced diabetes mellitus with diabetic cataractE09.39Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complicationE09.40Drug or chemical induced diabetes mellitus with neurological complications with diabeticneuropathy, unspecifiedE09.41Drug or chemical induced diabetes mellitus with neurological complications with diabeticmononeuropathyE09.42Drug or chemical induced diabetes mellitus with neurological complications with diabeticpolyneuropathyE09.43Drug or chemical induced diabetes mellitus with neurological complications with diabeticautonomic (poly)neuropathyE09.44Drug or chemical induced diabetes mellitus with neurological complications with diabeticamyotrophyE09.49Drug or chemical induced diabetes mellitus with neurological complications with other diabeticneurological complicationE09.51Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangreneE09.52Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangreneE09.59Drug or chemical induced diabetes mellitus with other circulatory complicationsE09.610Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathyE09.618Drug or chemical induced diabetes mellitus with other diabetic arthropathyE09.620Drug or chemical induced diabetes mellitus with diabetic dermatitisE09.621Drug or chemical induced diabetes mellitus with foot ulcerE09.622Drug or chemical induced diabetes mellitus with other skin ulcerE09.628Drug or chemical induced diabetes mellitus with other skin complicationsE09.630Drug or chemical induced diabetes mellitus with periodontal diseaseE09.638Drug or chemical induced diabetes mellitus with other oral complicationsE09.641Drug or chemical induced diabetes mellitus with hypoglycemia with comaE09.649Drug or chemical induced diabetes mellitus with hypoglycemia without comaE09.65Drug or chemical induced diabetes mellitus with hyperglycemiaE09.69Drug or chemical induced diabetes mellitus with other specified complicationE09.8Drug or chemical induced diabetes mellitus with unspecified complicationsE09.9Drug or chemical induced diabetes mellitus without complicationsE10.10Type 1 diabetes mellitus with ketoacidosis without comaE10.11Type 1 diabetes mellitus with ketoacidosis with comaE10.21Type 1 diabetes mellitus with diabetic nephropathyE10.22Type 1 diabetes mellitus with diabetic chronic kidney diseaseE10.29Type 1 diabetes mellitus with other diabetic kidney complicationE10.311Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edemaMedicare Limited Coverage Tests – Covered Diagnosis CodesSource: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) July 2015Effective October 1, 2015Medicare Limited Coverage Tests

Thyroid Testing Including TSHNational Coverage DeterminationCodeDescriptionE10.319Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edemaE10.321Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edemaE10.329Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edemaE10.331Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edemaE10.339Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macularedemaE10.341Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edemaE10.349Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edemaE10.351Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edemaE10.359Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edemaE10.36Type 1 diabetes mellitus with diabetic cataractE10.39Type 1 diabetes mellitus with other diabetic ophthalmic complicationE10.40Type 1 diabetes mellitus with diabetic neuropathy, unspecifiedE10.41Type 1 diabetes mellitus with diabetic mononeuropathyE10.42Type 1 diabetes mellitus with diabetic polyneuropathyE10.43Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathyE10.44Type 1 diabetes mellitus with diabetic amyotrophyE10.49Type 1 diabetes mellitus with other diabetic neurological complicationE10.51Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangreneE10.52Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangreneE10.59Type 1 diabetes mellitus with other circulatory complicationsE10.610Type 1 diabetes mellitus with diabetic neuropathic arthropathyE10.618Type 1 diabetes mellitus with other diabetic arthropathyE10.620Type 1 diabetes mellitus with diabetic dermatitisE10.621Type 1 diabetes mellitus with foot ulcerE10.622Type 1 diabetes mellitus with other skin ulcerE10.628Type 1 diabetes mellitus with other skin complicationsE10.630Type 1 diabetes mellitus with periodontal diseaseE10.638Type 1 diabetes mellitus with other oral complicationsE10.641Type 1 diabetes mellitus with hypoglycemia with comaE10.649Type 1 diabetes mellitus with hypoglycemia without comaE10.65Type 1 diabetes mellitus with hyperglycemiaE10.69Type 1 diabetes mellitus with other specified complicationE10.8Type 1 diabetes mellitus with unspecified complicationsE10.9Type 1 diabetes mellitus without complicationsE11.00Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolarcoma (NKHHC)E11.01Type 2 diabetes mellitus with hyperosmolarity with comaE11.21Type 2 diabetes mellitus with diabetic nephropathyE11.22Type 2 diabetes mellitus with diabetic chronic kidney diseaseE11.29Type 2 diabetes mellitus with other diabetic kidney complicationE11.311Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edemaE11.319Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edemaE11.321Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edemaE11.329Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edemaE11.331Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edemaE11.339Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macularedemaE11.341Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edemaE11.349Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edemaMedicare Limited Coverage Tests – Covered Diagnosis CodesSource: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) July 2015Effective October 1, 2015Medicare Limited Coverage Tests

Thyroid Testing Including TSHNational Coverage DeterminationCodeDescriptionE11.351Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edemaE11.359Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edemaE11.36Type 2 diabetes mellitus with diabetic cataractE11.39Type 2 diabetes mellitus with other diabetic ophthalmic complicationE11.40Type 2 diabetes mellitus with diabetic neuropathy, unspecifiedE11.41Type 2 diabetes mellitus with diabetic mononeuropathyE11.42Type 2 diabetes mellitus with diabetic polyneuropathyE11.43Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathyE11.44Type 2 diabetes mellitus with diabetic amyotrophyE11.49Type 2 diabetes mellitus with other diabetic neurological complicationE11.51Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangreneE11.52Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangreneE11.59Type 2 diabetes mellitus with other circulatory complicationsE11.610Type 2 diabetes mellitus with diabetic neuropathic arthropathyE11.618Type 2 diabetes mellitus with other diabetic arthropathyE11.620Type 2 diabetes mellitus with diabetic dermatitisE11.621Type 2 diabetes mellitus with foot ulcerE11.622Type 2 diabetes mellitus with other skin ulcerE11.628Type 2 diabetes mellitus with other skin complicationsE11.630Type 2 diabetes mellitus with periodontal diseaseE11.638Type 2 diabetes mellitus with other oral complicationsE11.641Type 2 diabetes mellitus with hypoglycemia with comaE11.649Type 2 diabetes mellitus with hypoglycemia without comaE11.65Type 2 diabetes mellitus with hyperglycemiaE11.69Type 2 diabetes mellitus with other specified complicationE11.8Type 2 diabetes mellitus with unspecified complicationsE11.9Type 2 diabetes mellitus without complicationsE13.00Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemichyperosmolar coma (NKHHC)E13.01Other specified diabetes mellitus with hyperosmolarity with comaE13.10Other specified diabetes mellitus with ketoacidosis without comaE13.11Other specified diabetes mellitus with ketoacidosis with comaE13.21Other specified diabetes mellitus with diabetic nephropathyE13.22Other specified diabetes mellitus with diabetic chronic kidney diseaseE13.29Other specified diabetes mellitus with other diabetic kidney complicationE13.311Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edemaE13.319Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edemaE13.321Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macularedemaE13.329Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macularedemaE13.331Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macularedemaE13.339Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy withoutmacular edemaE13.341Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macularedemaE13.349Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy withoutmacular edemaE13.351Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edemaE13.359Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edemaMedicare Limited Coverage Tests – Covered Diagnosis CodesSource: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) July 2015Effective October 1, 2015Medicare Limited Coverage Tests

Thyroid Testing Including TSHNational Coverage DeterminationCodeDescriptionE13.36Other specified diabetes mellitus with diabetic cataractE13.39Other specified diabetes mellitus with other diabetic ophthalmic complicationE13.40Other specified diabetes mellitus with diabetic neuropathy, unspecifiedE13.41Other specified diabetes mellitus with diabetic mononeuropathyE13.42Other specified diabetes mellitus with diabetic polyneuropathyE13.43Other specified diabetes mellitus with diabetic autonomic (poly)neuropathyE13.44Other specified diabetes mellitus with diabetic amyotrophyE13.49Other specified diabetes mellitus with other diabetic neurological complicationE13.51Other specified diabetes mellitus with diabetic peripheral angiopathy without gangreneE13.52Other specified diabetes mellitus with diabetic peripheral angiopathy with gangreneE13.59Other specified diabetes mellitus with other circulatory complicationsE13.610Other specified diabetes mellitus with diabetic neuropathic arthropathyE13.618Other specified diabetes mellitus with other diabetic arthropathyE13.620Other specified diabetes mellitus with diabetic dermatitisE13.621Other specified diabetes mellitus with foot ulcerE13.622Other specified diabetes mellitus with other skin ulcerE13.628Other specified diabetes mellitus with other skin complicationsE13.630Other specified diabetes mellitus with periodontal diseaseE13.638Other specified diabetes mellitus with other oral complicationsE13.641Other specified diabetes mellitus with hypoglycemia with comaE13.649Other specified diabetes mellitus with hypoglycemia without comaE13.65Other specified diabetes mellitus with hyperglycemiaE13.69Other specified diabetes mellitus with other specified complicationE13.8Other specified diabetes mellitus with unspecified complicationsE13.9Other specified diabetes mellitus without complicationsE20.0Idiopathic .8Other hypoparathyroidismE20.9Hypoparathyroidism, unspecifiedE22.1HyperprolactinemiaE22.8Other hyperfunction of pituitary glandE22.9Hyperfunction of pituitary gland, unspecifiedE23.0HypopituitarismE23.1Drug-induced hypopituitarismE23.6Other disorders of pituitary glandE25.0Congenital adrenogenital disorders associated with enzyme deficiencyE25.8Other adrenogenital disordersE25.9Adrenogenital disorder, unspecifiedE27.1Primary adrenocortical insufficiencyE27.2Addisonian crisisE27.3Drug-induced adrenocortical insu

CPT Codes: Code Description 84436 Thyroxine; total 84439 Thyroxine; free 84443 Thyroid stimulating hormone (TSH) 84479 Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR) Code Description A18.81 Tuberculosis of thyroid gland C56.1 Malignant neopl

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