About this policy
Jurisdiction: J6 MAC Part B. States: Illinois, Minnesota, Wisconsin. Type: Active LCD
Coverage indications
Indications and Limitations of Coverage The use of molecular testing (MT)* to assess thyroid nodules may be considered medically necessary ONCE per nodule workup when ALL of the following criteria are met: Thyroid fine-needle aspiration (s) (FNA) performed secondary to established indications based on ultrasound characteristics, size and clinical findings (1) Presence of indeterminate thyroid FNA cytopathology described as (1,2) Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) (i.e., Bethesda category III), or Follicular neoplasm (FN) or suspicious for a follicular neoplasm (SFN) (i.e., Bethesda category IV) The need for thyroidectomy is unclear after consideration of clinical, imaging, and cytologic features (1,2) Local institutional malignancy rates are known and used for optimal extrapolation of results to thyroid cancer risk (1) Informed patient willing to potentially undertake surveillance (1) *The scope of this LCD is limited to tests submitted on claims to NGS jurisdictions J6 and JK.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 81546 | CPT | Covered |
| 81599 | CPT | Covered |
| 0018U | HCPCS | Covered |
| 0026U | HCPCS | Covered |
| D44.0 | ICD10CM | Covered |
| D44.9 | ICD10CM | Covered |
| E01.0 | ICD10CM | Covered |
| E01.1 | ICD10CM | Covered |
| E01.2 | ICD10CM | Covered |
| E04.0 | ICD10CM | Covered |
| E04.1 | ICD10CM | Covered |
| E04.2 | ICD10CM | Covered |