About this policy
Jurisdiction: JM Part B. States: North Carolina, South Carolina, Virginia, West Virginia. Type: Active LCD
Coverage indications
Indications: Elevated serum levels of the amino acid homocysteine have been associated with increased risk of cardiovascular (CV) 3,16 and cerebrovascular 16 disease events as well as an increased risk of osteoporosis. 13,15,19 Elevated serum levels of homocysteine may reflect a deficiency of folate, vitamin B6, or vitamin B12. 7,16 The majority of hyperhomocysteinemia is caused by low levels of folate and vitamin B12 associated with anemia. Both vitamins are required for the metabolism of homocysteine to methionine. In the absence of either vitamin, this process cannot occur normally, and homocysteine accumulates. When initial testing results for vitamin B12 and/or folate levels are inconclusive, or if clinical findings are inconsistent with initial testing values, an elevated homocysteine level confirms the vitamin deficiency as the source of anemia. 10,18 Correcting nutritional inadequacy of folic acid and vitamin B12 will lower homocysteine levels in most patients. 4,5,7 However, the published evidence is insufficient to justify that such vitamin supplementation, while lowering the serum homocysteine levels, also reduces the risks for CV 1,2,8,11,12,14 or cerebrovascular 1,6,9,14 events or osteoporosis. 17 Medicare will cover homocysteine levels to confirm vitamin B12 or folate deficiency. In the absence of evidence that treatment of hyperhomocysteinemia reduces CV or cerebrovascular events, this test can only be covered in patients with known vascular disease or risk thereof (based upon abnormal lipid metabolism, high blood pressure (BP) or diabetes mellitus (DM)) for the purpose of risk stratification. In this circumstance it will be covered only once per lifetime. Limitations: When used to determine the risk of developing atherosclerotic CV disease or cerebrovascular disease, measurement of serum homocysteine levels in the absence of known vascular disease, hyperlipidemia, or DM will be denied as screening. Serum homocysteine levels for the evaluation of treatment of hyperhomocysteinemia in patients with CV or cerebrovascular risk factors will be denied as not medically necessary. Serum homocysteine levels for the evaluation of treatment of hyperhomocysteinemia in patients with osteoporosis or primary prevention of fracture will be denied as not medically necessary.
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 |
|---|---|---|
| 83090 | CPT | Covered |
| D51.0 | ICD10CM | Covered |
| D51.1 | ICD10CM | Covered |
| D51.2 | ICD10CM | Covered |
| D51.3 | ICD10CM | Covered |
| D51.8 | ICD10CM | Covered |
| D51.9 | ICD10CM | Covered |
| D52.0 | ICD10CM | Covered |
| D52.1 | ICD10CM | Covered |
| D52.8 | ICD10CM | Covered |
| D52.9 | ICD10CM | Covered |
| D53.1 | ICD10CM | Covered |