I'm a member

You will be redirected to myBlue. Would you like to continue?

member login

Find a Network Provider

be RxSmart

Community PLUS Pharmacy
Search

State & School Health Plan

Federal Employee Program

Member Links

Healthy You! Wellness Benefit »

Pay by Bank Draft »

View Our Medical Policy »

Military Benefit Information »

Fight Fraud »

Medical Policy Search

Printer Friendly Version Heavy Metal Testing

Heavy Metal Testing

DESCRIPTION

The term heavy metal testing is historically used to describe elements such as lead, arsenic, mercury, cadmium, and chromium. In general, all of the heavy metals in inorganic form cause GI irritation, resulting in nausea, vomiting, abdominal pain and diarrhea. The next most consistent toxicity for the heavy metals as a group, but not for every heavy metal, is renal toxicity. A further generalization is that each member of the heavy metal group tends to cause multi-organ toxicity. Many metals cause cutaneous abnormalities, such as irritant and allergic contact dermatitis, urticaria, keratoses, and premalignant and malignant lesions. Several of the heavy metals produce central and peripheral nervous system toxicity. Other metals cause pulmonary illness.

However, before any testing for heavy metal is ordered, a detailed medical history of the patient must be obtained, including a careful documentation of occupational and avocational exposure to these toxins. A complete physical examination must be done.

Documented recent, long-term total parenteral nutrition (TPN) with clinical trace element deficiency evidence is acceptable medical indications for testing for copper, manganese, and zinc.

POLICY

Procedure	Coverage Criteria	Covered Diagnoses
Aluminum 82108	Serum aluminum testing is considered medically necessary for individuals who have been on dialysis with evidence suggesting aluminum toxicity, or for individuals with chronic industrial exposure history	292.2, Pathological Drug Intoxication 292.81, Drug-Induced Delirium 292.82, Drug-Induced Persisting Dementia 292.83, Drug-Induced Persisting Amnestic Disorder 292.84, Drug-Induced Mood Disorder 292.89, Other Specified Drug-Induced Mental Disorders 293.9, Unspecified Transient Mental Disorder In Conditions Classified Elsewhere 294.8, Other Persistent Mental Disorders Due To Conditions Classified Elsewhere 503, Pneumoconiosis due to other inorganic dust 585.1 - 585.6, Chronic Kidney Disease, Stage I - End Stage Renal Disease 585.9, Chronic Kidney Disease, Unspecified 973.0, Poisoning By Antacids And Antigastric Secretion Drugs 985.8, Toxic Effect Of Other Specified Metals 996.73, Other Complications Due To Renal Dialysis Device Implant And Graft E943.0, Antacids and antigastric secretion drugs causing adverse effect in therapeutic use V45.11, Renal dialysis status V45.12, Noncompliance with renal dialysis
Antimony 83015 83018	Serum and/or urine antimony testing is considered medically necessary for individuals with documented treatment in the past with antileishmaniasis agents or with documented chronic antimony industrial exposure history.	085.9, Leishmaniasis Unspecified 985.4, Toxic Effect Of Antimony And Its Compounds 961.2, Poisoning by heavy metal anti-infectives E866.2, Accidental poisoning by antimony and its compounds and fumes E931.2, Heavy metal anti-infectives causing adverse effect in therapeutic use
Arsenic 82175	Serum and whole blood and/or urine arsenic testing is considered medically necessary for individuals with unexplained peripheral neuropathies, industrial exposure to arsenic, histories of arsenic pesticide exposure, unexplained encephalopathies, unexplained weight loss, chronic glomerulonephritis, bone marrow hypoplasia, or melanosis of skin, unexplained chronic diarrhea, persistent abdominal pain, or nausea and vomiting.	284.89, Other Specified Aplastic Anemias 348.30, Encephalopathy Unspecified 348.31, Metabolic Encephalopathy 348.39, Other Encephalopathy 356.0, Hereditary Peripheral Neuropathy 356.9, Unspecified Idiopathic Peripheral Neuropathy 357.7, Polyneuropathy Due To Other Toxic Agents 569.89, Other Specified Disorders Of Intestines 582.9, Chronic Glomerulonephritis With Unspecified Pathological Lesion In Kidney 692.4, Contact Dermatitis And Other Eczema Due To Other Chemical Products 783.21, Loss Of Weight 787.01, Nausea With Vomiting 787.91, Diarrhea 961.1, Poisoning By Arsenical Anti-Infectives 985.1, Toxic Effect Of Arsenic And Its Compounds E866.3, Accidental poisoning by arsenic and its compounds and fumes E931.1, Arsenical anti-infectives causing adverse effect in therapeutic use E950.8, Suicide and self-inflicted poisoning by arsenic and its compounds V87.01, Contact with and (suspected) exposure to arsenic
Barium 83015 83018	Serum and or/urine barium testing is considered medically necessary for individuals with pulmonary disease with industrial exposure to barium or unexplained flaccid paralysis.	342.00, Flaccid hemiplegia affecting unspecified side 342.01, Flaccid hemiplegia affecting dominant side 342.02, Flaccid hemiplegia affecting nondominant side 518.89, Other Diseases Of Lung Not Elsewhere Classified 503, Pneumoconiosis due to other inorganic dust 985.8, Toxic Effect Of Other Specified Metals
Beryllium 83015 83018	Serum and/or urine beryllium testing is considered medically necessary for individuals with pulmonary disease with industrial exposure to beryllium.	503, Pneumoconiosis due to other inorganic dust 518.89, Other Diseases Of Lung Not Elsewhere Classified 985.3, Toxic Effect Of Beryllium And Its Compounds E866.4, Accidental poisoning by other metals and their compounds and fumes
Bismuth 83015 83018	Serum and/or urine bismuth testing is considered medically necessary for individuals with bismuth lines on their gums, methemoglobinemia, unexplained pathological fractures, or a history of bismuth medicine abuse.	289.7, Methemoglobinemia 523.8, Other Specified Periodontal Diseases 733.10, Pathological Fracture Unspecified Site 961.2, Poisoning by heavy metal anti-infectives 985.8, Toxic Effect Of Other Specified Metals E931.2,Heavy metal anti-infectives causing adverse effect in therapeutic use E943.5,Antidiarrheal drugs causing adverse effect in therapeutic use
Cadmium 82300	Serum and whole blood and/or urine cadmium testing is considered medically necessary for individuals with an exposure to cadmium with evidence of pulmonary disease or unexplained renal failure.	518.89, Other Diseases Of Lung Not Elsewhere Classified 586, Renal Failure Unspecified 985.5, Toxic Effect Of Cadmium And Its Compounds E866.4, Accidental poisoning by other metals and their compounds and fumes
Chromium 82495	Serum chromium testing is considered medically necessary for individuals with an industrial exposure to chromium with evidence of pulmonary disease.	518.89, Other Diseases Of Lung Not Elsewhere Classified 985.6, Toxic Effect Of Chromium V87.09, Contact with and (suspected) exposure to other hazardous metals
Cobalt 84999	Serum cobalt testing is considered medically necessary for individuals with an industrial exposure to cobalt with evidence of pulmonary disease	502, Pneumoconiosis due to other silica or silicates 790.6, Other abnormal blood chemistry E866.4, Accidental poisoning by other metals and their compounds and fumes 518.89, Other Diseases Of Lung Not Elsewhere Classified 790.6, Other abnormal blood chemistry 985.8, Toxic Effect Of Other Specified Metals
Copper 82525	Serum copper testing is considered medically necessary for individuals with an industrial exposure to copper with evidence of pulmonary disease, or for individuals with Wilson’s Disease, unexplained cardiomyopathy, unexplained renal failure, polycythemia.	275.1, Disorders Of Copper Metabolism 425.9, Secondary Cardiomyopathy Unspecified 502, Pneumoconiosis due to other silica or silicates 518.89, Other Diseases Of Lung Not Elsewhere Classified 571.40, Chronic Hepatitis Unspecified 571.41, Chronic Persistent Hepatitis 571.5, Cirrhosis Of Liver Without Alcohol 571.9, Unspecified Chronic Liver Disease Without Alcohol 573.9, Unspecified Disorder Of Liver 586, Renal Failure Unspecified 759.89, Other Specified Congenital Anomalies 783.3, Feeding Difficulties And Mismanagement 790.5, Other Nonspecific Abnormal Serum Enzyme Levels 985.8, Toxic Effect Of Other Specified Metals 790.6, Other abnormal blood chemistry E866.4, Accidental poisoning by other metals and their compounds and fumes
Iron 83540	erum iron may be considered medically necessary for evaluation of toxic effects of iron and other metals (e.g., nickel, cadmium, aluminum, and lead) whether due to accidental, intentional exposure or metabolic causes.	275.09, Other disorders of iron metabolism 790.6, Other abnormal blood chemistry 984.0-984.9, Toxic effect of lead and its compounds (including fumes) 985.8,Toxic effect of other specified metals 964.0, Poisoning by agents primarily affecting blood constituents, iron compounds E858.2, Accidental poisoning by agents primarily affecting blood constituents E934.0, Iron and its compounds causing adverse effect in therapeutic use
Lead 83655	Blood (serum and whole) and/or urine lead testing is considered medically necessary if there is documented industrial exposure to lead, documented avocation exposure to lead, retained bullet fragments at or near joints, a blue gum line, a history of moonshine abuse, unexplained peripheral neuropathies, evidence of lead contaminated drinking water, paint stripping, lead lines on bones on radiographs, or basophilic stippling of red blood cells.	348.30, Encephalopathy Unspecified 348.31, Metabolic Encephalopathy 348.39, Other Encephalopathy 354.8, Other Mononeuritis Of Upper Limb 354.9, Mononeuritis Of Upper Limb Unspecified 355.8, Mononeuritis Of Lower Limb Unspecified 355.9, Mononeuritis Of Unspecified Site 356.0, Hereditary Peripheral Neuropathy 356.1, Peroneal Muscular Atrophy 356.2, Hereditary Sensory Neuropathy 356.3, Refsum's Disease 356.4, Idiopathic Progressive Polyneuropathy 356.8, Other Specified Idiopathic Peripheral Neuropathy 356.9, Unspecified Idiopathic Peripheral Neuropathy 503, Pneumoconiosis due to other inorganic dust 790.01, Precipitous Drop In Hematocrit 790.09, Other Abnormality Of Red Blood Cells 793.7, Nonspecific (Abnormal) Findings On Radiological And Other Examination Of Musculoskeletal System 961.2, Poisoning by heavy metal anti-infectives 984.0, Toxic Effect Of Inorganic Lead Compounds 984.1, Toxic Effect Of Organic Lead Compounds 984.8, Toxic Effect Of Other Lead Compounds 984.9, Toxic Effect Of Unspecified Lead Compound E861.5, Accidental poisoning by lead paints E866.4, Accidental poisoning by other metals and their compounds and fumes E931.2, Heavy metal anti-infectives causing adverse effect in therapeutic use
Lithium 80178	Serum and/or urine lithium testing is considered medically necessary for individuals on lithium medications.	296.00, Bipolar I Disorder, Single Manic Episode, Unspecified 296.01, Bipolar I Disorder, Single Manic Episode, Mild 296.02, Bipolar I Disorder, Single Manic Episode, Moderate 296.03, Bipolar I Disorder, Single Manic Episode, Severe, Without Mention Of Psychotic Behavior 296.04, Bipolar I Disorder, Single Manic Episode, Severe, Specified As With Psychotic Behavior 296.05, Bipolar I Disorder, Single Manic Episode, In Partial Or Unspecified Remission 296.06, Bipolar I Disorder, Single Manic Episode, In Full Remission 296.10, Manic Affective Disorder Recurrent Episode Unspecified Degree 296.11, Manic Affective Disorder Recurrent Episode Mild Degree 296.12, Manic Affective Disorder Recurrent Episode Moderate Degree 296.13, Manic Affective Disorder Recurrent Episode Severe Degree Without Psychotic Behavior 296.14, Manic Affective Disorder Recurrent Episode Severe Degree Specified As With Psychotic Behavior 296.15, Manic Affective Disorder Recurrent Episode In Partial Or Unspecified Remission 296.16, Manic Affective Disorder Recurrent Episode In Full Remission 296.20, Major Depressive Affective Disorder Single Episode Unspecified Degree 296.21, Major Depressive Affective Disorder Single Episode Mild Degree 296.22, Major Depressive Affective Disorder Single Episode Moderate Degree 296.23, Major Depressive Affective Disorder Single Episode Severe Degree Without Psychotic Behavior 296.24, Major Depressive Affective Disorder Single Episode Severe Degree Specified As With Psychotic Behavior 296.25, Major Depressive Affective Disorder Single Episode In Partial Or Unspecified Remission 296.26, Major Depressive Affective Disorder Single Episode In Full Remission 296.30, Major Depressive Affective Disorder Recurrent Episode Unspecified Degree 296.31, Major Depressive Affective Disorder Recurrent Episode Mild Degree 296.32, Major Depressive Affective Disorder Recurrent Episode Moderate Degree 296.33, Major Depressive Affective Disorder Recurrent Episode Severe Degree Without Psychotic Behavior 296.34, Major Depressive Affective Disorder Recurrent Episode Severe Degree Specified As With Psychotic Behavior 296.35, Major Depressive Affective Disorder Recurrent Episode In Partial Or Unspecified Remission 296.36, Major Depressive Affective Disorder Recurrent Episode In Full Remission 296.40, Bipolar I Disorder, Most Recent Episode (Or Current) Manic, Unspecified 296.41, Bipolar I Disorder, Most Recent Episode (Or Current) Manic, Mild 296.42, Bipolar I Disorder, Most Recent Episode (Or Current) Manic, Moderate 296.43, Bipolar I Disorder, Most Recent Episode (Or Current) Manic, Severe, Without Mention Of Psychotic Behavior 296.44, Bipolar I Disorder, Most Recent Episode (Or Current) Manic, Severe, Specified As With Psychotic Behavior 296.45, Bipolar I Disorder, Most Recent Episode (Or Current) Manic, In Partial Or Unspecified Remission 296.46, Bipolar I Disorder, Most Recent Episode (Or Current) Manic, In Full Remission 296.50, Bipolar I Disorder, Most Recent Episode (Or Current) Depressed, Unspecified 296.51, Bipolar I Disorder, Most Recent Episode (Or Current) Depressed, Mild 296.52, Bipolar I Disorder, Most Recent Episode (Or Current) Depressed, Moderate 296.53, Bipolar I Disorder, Most Recent Episode (Or Current) Depressed, Severe, Without Mention Of Psychotic Behavior 296.54, Bipolar I Disorder, Most Recent Episode (Or Current) Depressed, Severe, Specified As With Psychotic Behavior 296.55, Bipolar I Disorder, Most Recent Episode (Or Current) Depressed, In Partial Or Unspecified Remission 296.56, Bipolar I Disorder, Most Recent Episode (Or Current) Depressed, In Full Remission 296.60, Bipolar I Disorder, Most Recent Episode (Or Current) Mixed, Unspecified 296.61, Bipolar I Disorder, Most Recent Episode (Or Current) Mixed, Mild 296.62, Bipolar I Disorder, Most Recent Episode (Or Current) Mixed, Moderate 296.63, Bipolar I Disorder, Most Recent Episode (Or Current) Mixed, Severe, Without Mention Of Psychotic Behavior 296.64, Bipolar I Disorder, Most Recent Episode (Or Current) Mixed, Severe, Specified As With Psychotic Behavior 296.65, Bipolar I Disorder, Most Recent Episode (Or Current) Mixed, In Partial Or Unspecified Remission 296.66, Bipolar I Disorder, Most Recent Episode (Or Current) Mixed, In Full Remission 296.7, Bipolar I Disorder, Most Recent Episode (Or Current) Unspecified 296.80, Bipolar Disorder, Unspecified 296.81, Atypical Manic Disorder 296.82, Atypical Depressive Disorder 296.89, Other And Unspecified Bipolar Disorders, Other 296.90, Unspecified Episodic Mood Disorder 296.99, Other Specified Episodic Mood Disorder 311, Depressive Disorder Not Elsewhere Classified 790.6, Other abnormal blood chemistry 969.8, Poisoning By Other Specified Psychotropic Agents 985.8, Toxic Effect Of Other Specified Metals V58.63, Long-Term (Current) Use Of Antiplatelets/Antithrombotics V58.64, Long-Term (Current) Use Of Nonsteroidal Anti-Inflammatories V58.65, Long-Term (Current) Use Of Steroids V58.69, Long-Term (Current) Use Of Other Medications V58.83, Encounter For Therapeutic Drug Monitoring
Manganese 83785	Serum manganese testing is considered medically necessary for individuals with documented industrial exposure to manganese.	333.90, Unspecified Extrapyramidal Disease And Abnormal Movement Disorder 333.99, Other Extrapyramidal Diseases And Abnormal Movement Disorders 783.3, Feeding Difficulties And Mismanagement 985.2, Toxic Effect Of Manganese And Its Compounds E866.4, Accidental poisoning by other metals and their compounds and fumes
Mercury 83825	Serum, whole blood, and/or urine mercury testing is considered medically necessary for individuals with documented industrial exposure to mercury, with a blue line in their mouth, those with a history of laxative abuse, with a history of pesticide exposure, mercury spillage with vacuuming of the liquid metal, unexplained renal failure, or a history of skin lightening treatments.	305.9, Other, mixed, or unspecified nondependent drug abuse 333.90, Unspecified Extrapyramidal Disease And Abnormal Movement Disorder 333.99, Other Extrapyramidal Diseases And Abnormal Movement Disorders 334.0, Friedreich's Ataxia 334.3, Other Cerebellar Ataxia 334.4, Cerebellar Ataxia In Diseases Classified Elsewhere 438.84, Ataxia 586, Renal Failure Unspecified 692.3, Contact dermatitis and other eczema due to drugs and medicines in contact with skin 781.3, Lack Of Coordination 961.2, Poisoning By Heavy Metal Anti-Infectives 973.3, Poisoning By Other Cathartics Including Intestinal Atonia 974.0, Poisoning by mercurial diuretics 976.8, Poisoning By Other Agents Primarily Affecting Skin And Mucous Membrane 985.0, Toxic Effect Of Mercury And Its Compounds E863.6, Accidental poisoning by fungicides E944.0, Mercurial diuretics causing adverse effect in therapeutic use
Molybdenum 84999	Serum molybdenum testing is considered medically necessary for individuals with documented industrial exposure to molybdenum.	985.8, Toxic Effect Of Other Specified Metals
Nickel 83885	Serum and/or urine nickel testing is considered medically necessary for individuals with documented industrial exposure to nickel, unexplained renal failure, unexplained pulmonary disease.	518.89, Other Diseases Of Lung Not Elsewhere Classified 586, Renal Failure Unspecified 985.8, Toxic Effect Of Other Specified Metals E866.4, Accidental poisoning by other metals and their compounds and fumes V87.09, Contact with and (suspected) exposure to other hazardous metals
Selenium 84255	Serum and/or urine selenium testing is considered medically necessary for individuals with documented industrial exposure to selenium or on chronic renal dialysis.	586, Renal Failure Unspecified 985.8, Toxic Effect Of Other Specified Metals V45.11, Renal dialysis status V45.12, Noncompliance with renal dialysis
Thallium 84999	Serum thallium testing is considered medically necessary for individuals with documented industrial exposure to thallium and unexplained ataxia.	357.7, Polyneuropathy Due To Other Toxic Agents 781.3, Lack Of Coordination 985.8, Toxic Effect Of Other Specified Metals
Tin 84999	Serum tin testing is considered medically necessary for individuals with documented industrial exposure to tin.	985.8, Toxic Effect Of Other Specified Metals
Titanium 84999	Serum titanium testing is considered medically necessary for individuals with documented industrial exposure to titanium.	985.8, Toxic Effect Of Other Specified Metals
Zinc 84630	Serum zinc and/or urine testing is considered medically necessary for individuals with documented industrial exposure to zinc, on chronic renal dialysis, with malabsorption syndromes and Crohn’s disease	555.9, Regional Enteritis Of Unspecified Site 579.9, Unspecified Intestinal Malabsorption 586, Renal Failure Unspecified 783.3, Feeding Difficulties And Mismanagement 790.6, Other abnormal blood chemistry 972.7, Poisoning by antivaricose drugs, including sclerosing agents chemistry 985.8, Toxic Effect Of Other Specified Metals E924.7, Antivaricose drugs, including sclerosing agents, causing adverse effect in therapeutic use

POLICY EXCEPTIONS

None

POLICY GUIDELINES

Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

POLICY HISTORY

07/19/2012: Approved by Medical Policy Advisory Committee.

SOURCE(S)

Wisconsin Physicians Service Heavy Metal Testing Local Coverage Determination

Medicare National Coverage Determination 190.18 - Serum Iron Studies

U.S. Preventive Services Task Force, USPSTF A-Z Topic Guide. U.S. Preventive Services Task Force.

CODE REFERENCE

Covered Codes

See table in "Policy" section above. This is not intended to be a comprehensive list of codes. Some covered procedure codes have multiple descriptions.

The code(s) listed are ONLY covered if the procedure is performed according to the "Policy" section of this document.

Top