Thyroid Testing Including TSH National Coverage …

1 Medicare Limited Coverage Tests Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) July 2015 Effective October 1, 2015 Medicare Limited Coverage Tests Thyroid Testing Including TSH National Coverage Determination 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 Tuberculosis of Thyroid gland Malignant neoplasm of right ovary Malignant neoplasm of left ovary Malignant neoplasm of unspecified ovary C73 Malignant neoplasm of Thyroid gland Malignant neoplasm with pluriglandular involvement.

2 Unspecified Secondary malignant neoplasm of other specified sites Secondary malignant neoplasm of unspecified site Carcinoma in situ of Thyroid and other endocrine glands Carcinoma in situ of other specified sites Benign neoplasm of right ovary Benign neoplasm of left ovary Benign neoplasm of unspecified ovary D34 Benign neoplasm of Thyroid gland Benign neoplasm of pituitary gland Benign neoplasm of craniopharyngeal duct Neoplasm of uncertain behavior of Thyroid gland Neoplasm of uncertain behavior of parathyroid gland Neoplasm of uncertain behavior of unspecified endocrine gland Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system Vitamin B12 deficiency anemia due to intrinsic factor deficiency Nutritional anemia, unspecified drug -induced autoimmune hemolytic anemia Other autoimmune hemolytic anemias Anemia, unspecified Autoimmune lymphoproliferative syndrome [ALPS] Other specified disorders involving the immune mechanism, not elsewhere classified Congenital iodine-deficiency syndrome, neurological type Congenital iodine-deficiency syndrome, myxedematous type Congenital iodine-deficiency syndrome, mixed type Congenital iodine-deficiency syndrome, unspecified Iodine-deficiency related diffuse (endemic) goiter Iodine-deficiency related multinodular (endemic)

3 Goiter Iodine-deficiency related (endemic) goiter, unspecified Other iodine-deficiency related Thyroid disorders and allied conditions E02 Subclinical iodine-deficiency hypothyroidism Congenital hypothyroidism with diffuse goiter Congenital hypothyroidism without goiter Medicare Limited Coverage Tests Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) July 2015 Effective October 1, 2015 Medicare Limited Coverage Tests Thyroid Testing Including TSH National Coverage Determination Code Description Hypothyroidism due to medicaments and other exogenous substances Postinfectious hypothyroidism Atrophy of Thyroid (acquired)

4 Myxedema coma Other specified hypothyroidism Hypothyroidism, unspecified Nontoxic diffuse goiter Nontoxic single Thyroid nodule Nontoxic multinodular goiter Other specified nontoxic goiter Nontoxic goiter, unspecified Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or storm Thyrotoxicosis with toxic single Thyroid nodule without thyrotoxic crisis or storm Thyrotoxicosis with toxic single Thyroid nodule with thyrotoxic crisis or storm Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or storm Thyrotoxicosis with toxic multinodular goiter with thyrotoxic crisis or storm Thyrotoxicosis from ectopic Thyroid tissue without thyrotoxic crisis or storm Thyrotoxicosis from ectopic Thyroid tissue with thyrotoxic crisis or storm Thyrotoxicosis factitia without thyrotoxic crisis

5 Or storm Thyrotoxicosis factitia with thyrotoxic crisis or storm Other thyrotoxicosis without thyrotoxic crisis or storm Other thyrotoxicosis with thyrotoxic crisis or storm Thyrotoxicosis, unspecified without thyrotoxic crisis or storm Thyrotoxicosis, unspecified with thyrotoxic crisis or storm Acute thyroiditis Subacute thyroiditis Chronic thyroiditis with transient thyrotoxicosis Autoimmune thyroiditis drug -induced thyroiditis Other chronic thyroiditis Thyroiditis, unspecified Hypersecretion of calcitonin Dyshormogenetic goiter Other specified disorders of Thyroid Disorder of Thyroid , unspecified Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)

6 Diabetes mellitus due to underlying condition with hyperosmolarity with coma Diabetes mellitus due to underlying condition with ketoacidosis without coma Diabetes mellitus due to underlying condition with ketoacidosis with coma Diabetes mellitus due to underlying condition with diabetic nephropathy Diabetes mellitus due to underlying condition with diabetic chronic kidney disease Diabetes mellitus due to underlying condition with other diabetic kidney complication Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema Medicare Limited Coverage Tests Covered Diagnosis Codes Source.

7 National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) July 2015 Effective October 1, 2015 Medicare Limited Coverage Tests Thyroid Testing Including TSH National Coverage Determination Code Description Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema Diabetes mellitus due to underlying condition with severe nonproliferative diabetic

8 Retinopathy without macular edema Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema Diabetes mellitus due to underlying condition with diabetic cataract Diabetes mellitus due to underlying condition with other diabetic ophthalmic complication Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified Diabetes mellitus due to underlying condition with diabetic mononeuropathy Diabetes mellitus due to underlying condition with diabetic polyneuropathy Diabetes mellitus due to underlying condition with diabetic autonomic (poly)

9 Neuropathy Diabetes mellitus due to underlying condition with diabetic amyotrophy Diabetes mellitus due to underlying condition with other diabetic neurological complication Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene Diabetes mellitus due to underlying condition with other circulatory complications Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy Diabetes mellitus due to underlying condition with other diabetic arthropathy Diabetes mellitus due to underlying condition with diabetic dermatitis Diabetes mellitus due to underlying condition with foot ulcer Diabetes mellitus due to underlying condition with other skin ulcer Diabetes mellitus due to underlying condition with other skin complications Diabetes mellitus due to underlying condition with periodontal disease Diabetes mellitus due to underlying condition with other oral complications Diabetes mellitus due to underlying condition with hypoglycemia with coma Diabetes mellitus due to underlying condition with hypoglycemia without coma Diabetes mellitus due to underlying condition with hyperglycemia Diabetes mellitus due to underlying condition with other specified complication Diabetes

10 Mellitus due to underlying condition with unspecified complications Diabetes mellitus due to underlying condition without complications drug or chemical induced diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic- hyperosmolar coma (NKHHC) drug or chemical induced diabetes mellitus with hyperosmolarity with coma drug or chemical induced diabetes mellitus with ketoacidosis without coma drug or chemical induced diabetes mellitus with ketoacidosis with coma drug or chemical induced diabetes mellitus with diabetic nephropathy drug or chemical induced diabetes mellitus with diabetic chronic kidney disease drug or chemical induced diabetes mellitus with other diabetic kidney complication drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema Medicare Limited