Measurement of Salivary Hormones

LCD Information Document Information Source LCD ID N/A LCD ID L36846 Original ICD-9 LCD ID Not Applicable LCD Title Measurement of Salivary Hormones Proposed LCD in Comment Period N/A Source Proposed LCD DL36846 Opens in a new window Original Effective Date For services performed on or after 07/21/2017 Revision Effective Date For services performed on or after 10/16/2025 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date 06/05/2017 Notice Period End Date 07/20/2017 CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. Current Dental Terminology © 2025 American Dental Association. All rights reserved. Copyright © 2026, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at ub04@aha.org or 312‐422‐3366. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates. Issue Issue Description This update is to consolidate JE and JF to have one unified document and policy number. Issue - Explanation of Change Between Proposed LCD and Final LCD CMS National Coverage Policy Code of Federal Regulations:42 CFR Sections 410.32(a) & 410.32(a)(3) require that clinical laboratory services be ordered and used promptly by the physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who is treating the beneficiary.42CFR411.15 excludes from coverage examinations performed for a purpose other than treatment or diagnosis of a specific illness, symptoms, complaint, or injury with specific legislative enactments as the only exceptions.CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, §§20.4.4 and 20.4.5. Coverage Indications, Limitations, and/or Medical Necessity Hormones, both endocrine and exocrine, are secreted into various bodily fluids and their measurement can often diagnose diseases or be used to follow the course of a disease. Traditionally endocrine hormones are measured in serum, plasma, or urine. Measurements of hormones at certain times of the day, or after various attempts at suppression or stimulation can be used for diagnoses of endocrine diseases. Recently some labs have attempted to develop measurement of hormones in salivary secretions. Material is collected from saliva and sent to a lab for measurement. The convenience of collection without need of arterial or venipuncture simplifies collection, but the accuracy of measurement and lack of standardization makes the values determined still investigational. Noridian Healthcare Solutions currently considers salivary cortisol collected in the evening for diagnosis of Cushing’s syndrome as the only medically necessary and reasonable hormone measurement from salivary fluid. All other determinations of salivary hormones (e.g., thyroid, testosterone, estrogen, parathyroid, growth hormone, etc.) are considered investigational. Summary of Evidence N/A Analysis of Evidence (Rationale for Determination) N/A

Hormones, both endocrine and exocrine, are secreted into various bodily fluids and their measurement can often diagnose diseases or be used to follow the course of a disease. Traditionally endocrine hormones are measured in serum, plasma, or urine. Measurements of hormones at certain times of the day, or after various attempts at suppression or stimulation can be used for diagnoses of endocrine diseases. Recently some labs have attempted to develop measurement of hormones in salivary secretions. Material is collected from saliva and sent to a lab for measurement. The convenience of collection without need of arterial or venipuncture simplifies collection, but the accuracy of measurement and lack of standardization makes the values determined still investigational. Noridian Healthcare Solutions currently considers salivary cortisol collected in the evening for diagnosis of Cushing’s syndrome as the only medically necessary and reasonable hormone measurement from salivary fluid. All other determinations of salivary hormones (e.g., thyroid, testosterone, estrogen, parathyroid, growth hormone, etc.) are considered investigational.