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L.2.04.417
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.
Procedure | Coverage Criteria | Covered ICD-9 Diagnoses | Covered ICD-10 Diagnoses |
Aluminum82108 | 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 Intoxication292.81, Drug-Induced Delirium292.82, Drug-Induced Persisting Dementia292.83, Drug-Induced Persisting Amnestic Disorder292.84, Drug-Induced Mood Disorder292.89, Other Specified Drug-Induced Mental Disorders293.9, Unspecified Transient Mental Disorder In Conditions Classified Elsewhere294.8, Other Persistent Mental Disorders Due To Conditions Classified Elsewhere503, Pneumoconiosis due to other inorganic dust585.1 - 585.6, Chronic Kidney Disease, Stage I - End Stage Renal Disease585.9, Chronic Kidney Disease, Unspecified973.0, Poisoning By Antacids And Antigastric Secretion Drugs985.8, Toxic Effect Of Other Specified Metals996.73, Other Complications Due To Renal Dialysis Device Implant And GraftE943.0, Antacids and antigastric secretion drugs causing adverse effect in therapeutic useV45.11, Renal dialysis statusV45.12, Noncompliance with renal dialysis | F11.120, F11.121, F11.122, F11.129, F11.14, F11.159, F11.181, F11.188, F11.220, F11.221, F11.222, F11.229, F11.24, F11.259, F11.281, F11.288, F11.920, F11.921, F11.922, F11.929, F11.94, F11.959, F11.981, F11.988, Opioid related disordersF12.120, F12.121, F12.122, F12.129, F12.159, F12.180, F12.188, F12.220, F12.221, F12.222, F12.229, F12.23, F12.259, F12.280, F12.288, F12.920, F12.921, F12.922, F12.929, F12.93, F12.959, F12.980, F12.988 Cannabis related disorders F13.120, F13.121, F13.129, F13.14, F13.159, F13.180, F13.181, F13.188, F13.220, F13.221, F13.229, F13.24, F13.259, F13.26, F13.27, F13.280, F13.281, F13.288, F13.920, F13.921, F13.929, F13.94, F13.959, F13.96, F13.97, F13.980, F13.981, F13.988, Sedative, hypnotic, or anxiolytic related disorders F14.120, F14.121, F14.122, F14.129, F14.14, F14.159, F14.180, F14.181, F14.188, F14.220, F14.222, F14.221, F14.229, F14.24, F14.259, F14.280, F14.281, F14.288, F14.920, F14.921, F14.922, F14.929, F14.959, F14.980, F14.981, F14.988, F14.94, Cocaine related disorders F15.120, F15.121, F15.122, F15.129, F15.14, F15.159, F15.180, F15.181, F15.188, F15.220, F15.221, F15.222, F15.229, F15.24, F15.259, F15.280, F15.281, F15.288, F15.920, F15.921, F15.922, F15.929, F15.94, F15.959, F15.980, F15.981, F15.988, Other stimulant related disorders F16.120, F16.121, F16.122, F16.129, F16.14, F16.159, F16.180, F16.183, F16.188, F16.220, F16.221, F16.229, F16.24, F16.259, F16.280, F16.283, F16.288, F16.920, F16.921, F16.929, F16.94, F16.959, F16.980, F16.983, F16.988, Hallucinogen related disorders F17.208, F17.218, F17.228, F17.298, Nicotine dependence F18.120, F18.121, F18.129, F18.14, F18.159, F18.17, F18.180, F18.188, F18.220, F18.221, F18.229, F18.24, F18.259, F18.27, F18.280, F18.288, F18.921, F18.959, F18.97, F18.980, F18.988, Inhalant related disorders F19.120, F19.121, F19.122, F19.129, F19.14, F19.159, F19.16, F19.17, F19.180, F19.181, F19.188, F19.220, F19.221, F19.222, F19.229, F19.24, F19.259, F19.26, F19.27, F19.280, F19.281, F19.288, F19.920, F19.921, F19.922, F19.929, F19.94, F19.959, F19.96, F19.97, F19.980, F19.981, F19.988, Other psychoactive substance related disorders F06.8, Other specified mental disorders due to known physiological condition F06.0, Psychotic disorder with hallucinations due to known physiological condition F06.1, Catatonic disorder due to known physiological condition F06.8, Other specified mental disorders due to known physiological condition J63.0 - J63.6, Pneumoconiosis due to other inorganic dust N18.1 - N18.6, Chronic kidney disease code rangeN18.30, Chronic kidney disease, stage 3 unspecifiedN18.31, Chronic kidney disease, stage 3aN18.32, Chronic kidney disease, stage 3b N18.9, Chronic kidney disease, unspecified T47.0X1A, Poisoning by histamine H2-receptor blockers, accidental (unintentional), initial encounter T47.1X1A, Poisoning by other antacids and anti-gastric-secretion drugs, accidental (unintentional), initial encounter T56.4X1A, Toxic effect of copper and its compounds, accidental (unintentional), initial encounter T56.5X1A, Toxic effect of zinc and its compounds, accidental (unintentional), initial encounter T56.6X1A, Toxic effect of tin and its compounds, accidental (unintentional), initial encounter T56.811A, Toxic effect of thallium, accidental (unintentional), initial encounter T56.891A, Toxic effect of other metals, accidental (unintentional), initial encounter T82.818A, T82.828A, T82.838A, T82.848A, T82.858A, T82.868A, T82.898A, Other Complications Due To Renal Dialysis Device Implant And Graft T47.0X5A, Adverse effect of histamine H2-receptor blockers, initial encounter T47.0X5S, Adverse effect of histamine H2-receptor blockers, sequela T47.1X5A, Adverse effect of other antacids and anti-gastric-secretion drugs, initial encounter T47.1X5S, Adverse effect of other antacids and anti-gastric-secretion drugs, sequela Z99.2, Dependence on renal dialysis Z91.15, Patient's noncompliance with renal dialysis |
Antimony8301583018 | 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 Unspecified985.4, Toxic Effect Of Antimony And Its Compounds961.2, Poisoning by heavy metal anti-infectivesE866.2, Accidental poisoning by antimony and its compounds and fumesE931.2, Heavy metal anti-infectives causing adverse effect in therapeutic use | B55.9, Leishmaniasis, unspecified T56.891A, Toxic effect of other metals, accidental (unintentional), initial encounter T37.8X1A, Poisoning by other specified systemic anti-infectives and antiparasitics, accidental (unintentional), initial encounter T37.8X5A, Adverse effect of other specified systemic anti-infectives and antiparasitics, initial encounter |
Arsenic82175 | 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 Anemias348.30, Encephalopathy Unspecified348.31, Metabolic Encephalopathy348.39, Other Encephalopathy356.0, Hereditary Peripheral Neuropathy356.9, Unspecified Idiopathic Peripheral Neuropathy357.7, Polyneuropathy Due To Other Toxic Agents569.89, Other Specified Disorders Of Intestines582.9, Chronic Glomerulonephritis With Unspecified Pathological Lesion In Kidney692.4, Contact Dermatitis And Other Eczema Due To Other Chemical Products783.21, Loss Of Weight787.01, Nausea With Vomiting787.91, Diarrhea961.1, Poisoning By Arsenical Anti-Infectives985.1, Toxic Effect Of Arsenic And Its CompoundsE866.3, Accidental poisoning by arsenic and its compounds and fumesE931.1, Arsenical anti-infectives causing adverse effect in therapeutic useE950.8, Suicide and self-inflicted poisoning by arsenic and its compoundsV87.01, Contact with and (suspected) exposure to arsenic | D61.2, Aplastic anemia due to other external agents G93.40, Encephalopathy, unspecified G93.41, Metabolic encephalopathy G93.49, Other encephalopathy G60.0, Hereditary motor and sensory neuropathy G60.9, Hereditary and idiopathic neuropathy, unspecified G62.2, Polyneuropathy due to other toxic agents K63.4, Enteroptosis K63.89, Other specified diseases of intestine N03.9, Chronic nephritic syndrome with unspecified morphologic changes L25.3, Unspecified contact dermatitis due to other chemical products R63.4, Abnormal weight loss R11.2, Nausea with vomiting, unspecified R19.7, Diarrhea, unspecified T37.8X1A, Poisoning by other specified systemic anti-infectives and antiparasitics, accidental (unintentional), initial encounter T57.0X1A, Toxic effect of arsenic and its compounds, accidental (unintentional), initial encounter T37.8X5A, Adverse effect of other specified systemic anti-infectives and antiparasitics, initial encounter T57.0X2A, Toxic effect of arsenic and its compounds, intentional self-harm, initial encounter Z77.010, Contact with and (suspected) exposure to arsenic |
Barium8301583018 | 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 side342.01, Flaccid hemiplegia affecting dominant side342.02, Flaccid hemiplegia affecting nondominant side518.89, Other Diseases Of Lung Not Elsewhere Classified503, Pneumoconiosis due to other inorganic dust985.8, Toxic Effect Of Other Specified Metals | G81.00, Flaccid hemiplegia affecting unspecified side G81.01, Flaccid hemiplegia affecting right dominant side G81.02, Flaccid hemiplegia affecting left dominant side G81.03, Flaccid hemiplegia affecting right nondominant side G81.04, Flaccid hemiplegia affecting left nondominant side J98.4, Other disorders of lung J63.0 - J63.6, Pneumoconiosis due to other inorganic dust T56.4X1A, Toxic effect of copper and its compounds, accidental (unintentional), initial encounter T56.5X1A, Toxic effect of zinc and its compounds, accidental (unintentional), initial encounter T56.6X1A, Toxic effect of tin and its compounds, accidental (unintentional), initial encounter T56.811A, Toxic effect of thallium, accidental (unintentional), initial encounter T56.891A, Toxic effect of other metals, accidental (unintentional), initial encounter |
Beryllium 8301583018 | 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 dust518.89, Other Diseases Of Lung Not Elsewhere Classified985.3, Toxic Effect Of Beryllium And Its CompoundsE866.4, Accidental poisoning by other metals and their compounds and fumes | J63.0 - J63.6, Pneumoconiosis due to other inorganic dust J98.4, Other disorders of lung T56.7X1A, Toxic effect of beryllium and its compounds, accidental (unintentional), initial encounter |
Bismuth 8301583018 | 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, Methemoglobinemia523.8, Other Specified Periodontal Diseases733.10, Pathological Fracture Unspecified Site961.2, Poisoning by heavy metal anti-infectives985.8, Toxic Effect Of Other Specified MetalsE931.2, Heavy metal anti-infectives causing adverse effect in therapeutic useE943.5, Antidiarrheal drugs causing adverse effect in therapeutic use | D74.0 - D74.9, Methemoglobinemia code range K05.5, Other periodontal diseases K06.1, Gingival enlargement K06.2, Gingival and edentulous alveolar ridge lesions associated with trauma K06.8, Other specified disorders of gingiva and edentulous alveolar ridge M84.40XA, Pathological fracture, unspecified site, initial encounter for fracture M84.50XA, Pathological fracture in neoplastic disease, unspecified site, initial encounter for fracture M84.60XA, Pathological fracture in other disease, unspecified site, initial encounter for fracture T37.8X1A, Poisoning by other specified systemic anti-infectives and antiparasitics, accidental (unintentional), initial encounter T56.891A, Toxic effect of other metals, accidental (unintentional), initial encounter T37.8X5A, Adverse effect of other specified systemic anti-infectives and antiparasitics, initial encounter T47.6X5A, Adverse effect of antidiarrheal drugs, initial encounter T47.6X5S, Adverse effect of antidiarrheal drugs, sequela |
Cadmium82300 | 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 Classified586, Renal Failure Unspecified985.5, Toxic Effect Of Cadmium And Its CompoundsE866.4, Accidental poisoning by other metals and their compounds and fumes | J98.4, Other disorders of lung N19, Unspecified kidney failure T56.3X1A, Toxic effect of cadmium and its compounds, accidental (unintentional), initial encounter |
Chromium82495 | 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 Classified985.6, Toxic Effect Of ChromiumV87.09, Contact with and (suspected) exposure to other hazardous metals | J98.4, Other disorders of lung T56.2X1A, Toxic effect of chromium and its compounds, accidental (unintentional), initial encounter Z77.018, Contact with and (suspected) exposure to other hazardous metals |
Cobalt84999 | 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 chemistryE866.4, Accidental poisoning by other metals and their compounds and fumes518.89, Other Diseases Of Lung Not Elsewhere Classified790.6, Other abnormal blood chemistry985.8, Toxic Effect Of Other Specified Metals | J62.0 - J62.8, Pneumoconiosis due to dust containing silica R78.71, Abnormal lead level in blood R78.79, Finding of abnormal level of heavy metals in blood R78.89, Finding of other specified substances, not normally found in blood R79.0, Abnormal level of blood mineral T56.891A, Toxic effect of other metals, accidental (unintentional), initial encounter T56.91XA, Toxic effect of unspecified metal, accidental (unintentional), initial encounter J98.4, Other disorders of lung |
Copper82525 | 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 Metabolism425.9, Secondary Cardiomyopathy Unspecified502, Pneumoconiosis due to other silica or silicates 518.89, Other Diseases Of Lung Not Elsewhere Classified571.40, Chronic Hepatitis Unspecified571.41, Chronic Persistent Hepatitis571.5, Cirrhosis Of Liver Without Alcohol571.9, Unspecified Chronic Liver Disease Without Alcohol573.9, Unspecified Disorder Of Liver586, Renal Failure Unspecified759.89, Other Specified Congenital Anomalies783.3, Feeding Difficulties And Mismanagement790.5, Other Nonspecific Abnormal Serum Enzyme Levels985.8, Toxic Effect Of Other Specified Metals790.6, Other abnormal blood chemistryE866.4, Accidental poisoning by other metals and their compounds and fumes | E83.00 - E83.09, Disorders of copper metabolism I42.7, Cardiomyopathy due to drug and external agent J62.0 - J62.8, Pneumoconiosis due to dust containing silica J98.4, Other disorders of lung K73.9, Chronic hepatitis, unspecified K73.0, Chronic persistent hepatitis, not elsewhere classified K74.60 - K74.69, Other and unspecified cirrhosis of liver K76.9, Liver disease, unspecified N19, Unspecified kidney failure Q87.89, Other specified congenital malformation syndromes, not elsewhere classified Q89.8, Other specified congenital malformations (Deleted 09/30/2025)Q89.89, Other specified congenital malformations (New 10/01/2025) R63.30, R63.31, R63.32, R63.39, Feeding difficulties R74.8, Abnormal levels of other serum enzymes R74.9, Abnormal serum enzyme level, unspecified T56.4X1A, Toxic effect of copper and its compounds, accidental (unintentional), initial encounter R78.79, Finding of abnormal level of heavy metals in blood R79.0, Abnormal level of blood mineral T56.81XA, Toxic effect of other metals, accidental (unintentional), initial encounter T56.91XA, Toxic effect of unspecified metal, accidental (unintentional), initial encounter |
Iron83540 | Serum 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 metabolism790.6, Other abnormal blood chemistry984.0-984.9, 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 compoundsE858.2, Accidental poisoning by agents primarily affecting blood constituentsE934.0, Iron and its compounds causing adverse effect in therapeutic use | E83.10, Disorder of iron metabolism, unspecified E83.19, Other disorders of iron metabolism R78.71, Abnormal lead level in blood R78.79, Finding of abnormal level of heavy metals in blood R78.89, Finding of other specified substances, not normally found in blood R79.0, Abnormal level of blood mineral T56.0X1A, Toxic effect of lead and its compounds, accidental (unintentional), initial encounter T56.0X2A, Toxic effect of lead and its compounds, intentional self-harm, initial encounter T56.0X4A, Toxic effect of lead and its compounds, undetermined, initial encounter T56.4X1A, Toxic effect of copper and its compounds, accidental (unintentional), initial encounter T56.4X2A, Toxic effect of copper and its compounds, intentional self-harm, initial encounter T56.4X4A, Toxic effect of copper and its compounds, undetermined, initial encounter T56.5X1A, Toxic effect of zinc and its compounds, accidental (unintentional), initial encounter T56.5X2A, Toxic effect of zinc and its compounds, intentional self-harm, initial encounter T56.5X4A, Toxic effect of zinc and its compounds, undetermined, initial encounter T56.6X1A, Toxic effect of tin and its compounds, accidental (unintentional), initial encounter T56.6X2A, Toxic effect of tin and its compounds, intentional self-harm, initial encounter T56.6X4A, Toxic effect of tin and its compounds, undetermined, initial encounter T56.811A, Toxic effect of thallium, accidental (unintentional), initial encounter T56.812A, Toxic effect of thallium, intentional self-harm, initial encounter T56.814A, Toxic effect of thallium, undetermined, initial encounter T56.891A, Toxic effect of other metals, accidental (unintentional), initial encounter T56.892A, Toxic effect of other metals, intentional self-harm, initial encounter T56.894A, Toxic effect of other metals, undetermined, initial encounter T45.4X1A, Poisoning by iron and its compounds, accidental (unintentional), initial encounter T45.4X2A, Poisoning by iron and its compounds, intentional self-harm, initial encounter T45.4X4A, Poisoning by iron and its compounds, undetermined, initial encounter T45.4X1A, Poisoning by iron and its compounds, accidental (unintentional), initial encounter T45.4X5A, Adverse effect of iron and its compounds, initial encounter T45.4X5S, Adverse effect of iron and its compounds, sequela |
Lead83655 | 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 Unspecified348.31, Metabolic Encephalopathy348.39, Other Encephalopathy354.8, Other Mononeuritis Of Upper Limb354.9, Mononeuritis Of Upper Limb Unspecified355.8, Mononeuritis Of Lower Limb Unspecified355.9, Mononeuritis Of Unspecified Site356.0, Hereditary Peripheral Neuropathy356.1, Peroneal Muscular Atrophy356.2, Hereditary Sensory Neuropathy356.3, Refsum's Disease356.4, Idiopathic Progressive Polyneuropathy356.8, Other Specified Idiopathic Peripheral Neuropathy356.9, Unspecified Idiopathic Peripheral Neuropathy503, Pneumoconiosis due to other inorganic dust790.01, Precipitous Drop In Hematocrit790.09, Other Abnormality Of Red Blood Cells793.7, Nonspecific (Abnormal) Findings On Radiological And Other Examination Of Musculoskeletal System961.2, Poisoning by heavy metal anti-infectives984.0, Toxic Effect Of Inorganic Lead Compounds984.1, Toxic Effect Of Organic Lead Compounds984.8, Toxic Effect Of Other Lead Compounds984.9, Toxic Effect Of Unspecified Lead CompoundE861.5, Accidental poisoning by lead paintsE866.4, Accidental poisoning by other metals and their compounds and fumesE931.2, Heavy metal anti-infectives causing adverse effect in therapeutic use | G93.40, Encephalopathy, unspecified G93.41, Metabolic encephalopathy G93.49, Other encephalopathy G56.80 - G56.82, Other specified mononeuropathies of upper limb G56.90 - G56.92, Unspecified mononeuropathy of upper limb G57.90 - G57.92, Unspecified mononeuropathy of lower limb G58.8, Other specified mononeuropathies G58.9, Mononeuropathy, unspecified G59, Mononeuropathy in diseases classified elsewhere G60.0, Hereditary motor and sensory neuropathy G60.1, Refsum's disease G60.3, Idiopathic progressive neuropathy G60.8, Other hereditary and idiopathic neuropathies G60.9, Hereditary and idiopathic neuropathy, unspecified J63.0 - J63.6, Pneumoconiosis due to other inorganic dust R71.0, Precipitous drop in hematocrit R71.8, Other abnormality of red blood cells R78.71, Abnormal lead level in blood R93.7, Abnormal findings on diagnostic imaging of other parts of musculoskeletal system T37.8X1A, Poisoning by other specified systemic anti-infectives and antiparasitics, accidental (unintentional), initial encounter T56.0X1A - T56.0X4A, Toxic effect of lead and its compounds (including fumes) T56.891A, Toxic effect of other metals, accidental (unintentional), initial encounter T56.91XA, Toxic effect of unspecified metal, accidental (unintentional), initial encounter T37.8X5A, Adverse effect of other specified systemic anti-infectives and antiparasitics, initial encounter Z77.011, Contact with and (suspected) exposure to lead |
Lithium80178 | Serum and/or urine lithium testing is considered medically necessary for individuals on lithium medications. | 296.00, Bipolar I Disorder, Single Manic Episode, Unspecified296.01, Bipolar I Disorder, Single Manic Episode, Mild296.02, Bipolar I Disorder, Single Manic Episode, Moderate296.03, Bipolar I Disorder, Single Manic Episode, Severe, Without Mention Of Psychotic Behavior296.04, Bipolar I Disorder, Single Manic Episode, Severe, Specified As With Psychotic Behavior296.05, Bipolar I Disorder, Single Manic Episode, In Partial Or Unspecified Remission296.06, Bipolar I Disorder, Single Manic Episode, In Full Remission296.10, Manic Affective Disorder Recurrent Episode Unspecified Degree296.11, Manic Affective Disorder Recurrent Episode Mild Degree296.12, Manic Affective Disorder Recurrent Episode Moderate Degree296.13, Manic Affective Disorder Recurrent Episode Severe Degree Without Psychotic Behavior296.14, Manic Affective Disorder Recurrent Episode Severe Degree Specified As With Psychotic Behavior296.15, Manic Affective Disorder Recurrent Episode In Partial Or Unspecified Remission296.16, Manic Affective Disorder Recurrent Episode In Full Remission296.20, Major Depressive Affective Disorder Single Episode Unspecified Degree296.21, Major Depressive Affective Disorder Single Episode Mild Degree296.22, Major Depressive Affective Disorder Single Episode Moderate Degree296.23, Major Depressive Affective Disorder Single Episode Severe Degree Without Psychotic Behavior296.24, Major Depressive Affective Disorder Single Episode Severe Degree Specified As With Psychotic Behavior296.25, Major Depressive Affective Disorder Single Episode In Partial Or Unspecified Remission296.26, Major Depressive Affective Disorder Single Episode In Full Remission296.30, Major Depressive Affective Disorder Recurrent Episode Unspecified Degree296.31, Major Depressive Affective Disorder Recurrent Episode Mild Degree296.32, Major Depressive Affective Disorder Recurrent Episode Moderate Degree296.33, Major Depressive Affective Disorder Recurrent Episode Severe Degree Without Psychotic Behavior296.34, Major Depressive Affective Disorder Recurrent Episode Severe Degree Specified As With Psychotic Behavior296.35, Major Depressive Affective Disorder Recurrent Episode In Partial Or Unspecified Remission296.36, Major Depressive Affective Disorder Recurrent Episode In Full Remission296.40, Bipolar I Disorder, Most Recent Episode (Or Current) Manic, Unspecified296.41, Bipolar I Disorder, Most Recent Episode (Or Current) Manic, Mild296.42, Bipolar I Disorder, Most Recent Episode (Or Current) Manic, Moderate296.43, Bipolar I Disorder, Most Recent Episode (Or Current) Manic, Severe, Without Mention Of Psychotic Behavior296.44, Bipolar I Disorder, Most Recent Episode (Or Current) Manic, Severe, Specified As With Psychotic Behavior296.45, Bipolar I Disorder, Most Recent Episode (Or Current) Manic, In Partial Or Unspecified Remission296.46, Bipolar I Disorder, Most Recent Episode (Or Current) Manic, In Full Remission296.50, Bipolar I Disorder, Most Recent Episode (Or Current) Depressed, Unspecified296.51, Bipolar I Disorder, Most Recent Episode (Or Current) Depressed, Mild296.52, Bipolar I Disorder, Most Recent Episode (Or Current) Depressed, Moderate296.53, Bipolar I Disorder, Most Recent Episode (Or Current) Depressed, Severe, Without Mention Of Psychotic Behavior296.54, Bipolar I Disorder, Most Recent Episode (Or Current) Depressed, Severe, Specified As With Psychotic Behavior296.55, Bipolar I Disorder, Most Recent Episode (Or Current) Depressed, In Partial Or Unspecified Remission296.56, Bipolar I Disorder, Most Recent Episode (Or Current) Depressed, In Full Remission296.60, Bipolar I Disorder, Most Recent Episode (Or Current) Mixed, Unspecified296.61, Bipolar I Disorder, Most Recent Episode (Or Current) Mixed, Mild296.62, Bipolar I Disorder, Most Recent Episode (Or Current) Mixed, Moderate296.63, Bipolar I Disorder, Most Recent Episode (Or Current) Mixed, Severe, Without Mention Of Psychotic Behavior296.64, Bipolar I Disorder, Most Recent Episode (Or Current) Mixed, Severe, Specified As With Psychotic Behavior296.65, Bipolar I Disorder, Most Recent Episode (Or Current) Mixed, In Partial Or Unspecified Remission296.66, Bipolar I Disorder, Most Recent Episode (Or Current) Mixed, In Full Remission296.7, Bipolar I Disorder, Most Recent Episode (Or Current) Unspecified296.80, Bipolar Disorder, Unspecified296.81, Atypical Manic Disorder296.82, Atypical Depressive Disorder296.89, Other And Unspecified Bipolar Disorders, Other296.90, Unspecified Episodic Mood Disorder296.99, Other Specified Episodic Mood Disorder311, Depressive Disorder Not Elsewhere Classified790.6, Other abnormal blood chemistry969.8, Poisoning By Other Specified Psychotropic Agents985.8, Toxic Effect Of Other Specified MetalsV58.63, Long-Term (Current) Use Of Antiplatelets/AntithromboticsV58.64, Long-Term (Current) Use Of Nonsteroidal Anti-InflammatoriesV58.65, Long-Term (Current) Use Of SteroidsV58.69, Long-Term (Current) Use Of Other MedicationsV58.83, Encounter For Therapeutic Drug Monitoring | F30.9, Manic episode, unspecified F30.11, Manic episode without psychotic symptoms, mild F30.12, Manic episode without psychotic symptoms, moderate F30.13, Manic episode, severe, without psychotic symptoms F30.2, Manic episode, severe with psychotic symptoms 30.3, Manic episode in partial remission F30.4, Manic episode in full remission F30.10, Manic episode without psychotic symptoms, unspecified F32.9, Major depressive disorder, single episode, unspecified F32.0, Major depressive disorder, single episode, mild F32.1, Major depressive disorder, single episode, moderate F32.2, Major depressive disorder, single episode, severe without psychotic features F32.3, Major depressive disorder, single episode, severe with psychotic features F32.4, Major depressive disorder, single episode, in partial remission F32.5, Major depressive disorder, single episode, in full remission F33.9, Major depressive disorder, recurrent, unspecified F33.0, Major depressive disorder, recurrent, mild F33.1, Major depressive disorder, recurrent, moderate F33.2, Major depressive disorder, recurrent severe without psychotic features F33.3, Major depressive disorder, recurrent, severe with psychotic symptoms F33.41, Major depressive disorder, recurrent, in partial remission F33.42, Major depressive disorder, recurrent, in full remission F31.10, Bipolar disorder, current episode manic without psychotic features, unspecified F31.11, Bipolar disorder, current episode manic without psychotic features, mild F31.12, Bipolar disorder, current episode manic without psychotic features, moderate F31.13, Bipolar disorder, current episode manic without psychotic features, severe F31.2, Bipolar disorder, current episode manic severe with psychotic features F31.73, Bipolar disorder, in partial remission, most recent episode manic F31.74, Bipolar disorder, in full remission, most recent episode manic F31.30, Bipolar disorder, current episode depressed, mild or moderate severity, unspecified F31.31, Bipolar disorder, current episode depressed, mild F31.32, Bipolar disorder, current episode depressed, moderate F31.4, Bipolar disorder, current episode depressed, severe, without psychotic features F31.5, Bipolar disorder, current episode depressed, severe, with psychotic features F31.75, Bipolar disorder, in partial remission, most recent episode depressed F31.76, Bipolar disorder, in full remission, most recent episode depressed F31.60, Bipolar disorder, current episode mixed, unspecified F31.61, Bipolar disorder, current episode mixed, mild F31.62, Bipolar disorder, current episode mixed, moderate F31.63, Bipolar disorder current episode mixed, severe, without psychotic features F31.64, Bipolar disorder, current episode mixed, severe, with psychotic features F31.77, Bipolar disorder, in partial remission, most recent episode mixed F31.78, Bipolar disorder, in full remission, most recent episode mixed F31.70, Bipolar disorder, currently in remission, most recent episode unspecified F31.71, Bipolar disorder, in partial remission, most recent episode hypomanic F31.72, Bipolar disorder, in full remission, most recent episode hypomanic F31.9, Bipolar disorder, unspecified F30.8, Other manic episodes F32.89, Other specified depressive episodes F31.81, Bipolar II disorder F39, Unspecified mood [affective] disorder F34.81, Disruptive mood dysregulation disorder F34.89, Other specified persistent mood disorders F34.9, Persistent mood [affective] disorder, unspecified F32.9, Major depressive disorder, single episode, unspecified R78.89, Other specified abnormal findings of blood chemistry T43.8X1A, Poisoning by other psychotropic drugs, accidental (unintentional), initial encounter T43.8X2A, Poisoning by other psychotropic drugs, intentional self-harm, initial encounter T43.8X3A, Poisoning by other psychotropic drugs, assault, initial encounter T43.8X4A, Poisoning by other psychotropic drugs, undetermined, initial encounter T56.891A, Toxic effect of other metals, accidental (unintentional), initial encounter T56.892A, Toxic effect of other metals, intentional self-harm, initial encounter T56.893A, Toxic effect of other metals, assault, initial encounter T56.894A, Toxic effect of other metals, undetermined, initial encounter Z79.02, Long term (current) use of antithrombotics/antiplatelets Z79.1, Long term (current) use of non-steroidal anti-inflammatories (NSAID) Z79.51, Long term (current) use of inhaled steroids Z79.52, Long term (current) use of systemic steroids Z79.899, Other long term (current) drug therapy Z51.81, Encounter for therapeutic drug level monitoring |
Manganese83785 | Serum manganese testing is considered medically necessary for individuals with documented industrial exposure to manganese. | 333.90, Unspecified Extrapyramidal Disease And Abnormal Movement Disorder333.99, Other Extrapyramidal Diseases And Abnormal Movement Disorders783.3, Feeding Difficulties And Mismanagement985.2, Toxic Effect Of Manganese And Its CompoundsE866.4, Accidental poisoning by other metals and their compounds and fumes | G25.9, Extrapyramidal and movement disorder, unspecified G25.89, Other specified extrapyramidal and movement disorders R63.30, R63.31, R63.32, R63.39, Feeding difficulties T57.2X1A, Toxic effect of manganese and its compounds, accidental (unintentional), initial encounter T57.2X4A, Toxic effect of manganese and its compounds, undetermined, initial encounter Z77.018, Contact with and (suspected) exposure to other hazardous metals |
Mercury83825 | 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 abuse333.90, Unspecified Extrapyramidal Disease And Abnormal Movement Disorder333.99, Other Extrapyramidal Diseases And Abnormal Movement Disorders334.0, Friedreich's Ataxia334.3, Other Cerebellar Ataxia334.4, Cerebellar Ataxia In Diseases Classified Elsewhere438.84, Ataxia586, Renal Failure Unspecified692.3, Contact dermatitis and other eczema due to drugs and medicines in contact with skin781.3, Lack Of Coordination961.2, Poisoning By Heavy Metal Anti-Infectives973.3, Poisoning By Other Cathartics Including Intestinal Atonia974.0, Poisoning by mercurial diuretics976.8, Poisoning by other agents primarily affecting skin and mucous membrane985.0, Toxic Effect Of Mercury And Its CompoundsE863.6, Accidental poisoning by fungicidesE944.0, Mercurial diuretics causing adverse effect in therapeutic use | F55.2, Abuse of laxatives G25.9, Extrapyramidal and movement disorder, unspecified G25.89, Other specified extrapyramidal and movement disorders G11.10, Early-onset cerebellar ataxia, unspecifiedG11.19, Other early-onset cerebellar ataxia G32.8, Cerebellar ataxia in diseases classified elsewhere I69.893, Ataxia following other cerebrovascular disease I69.993, Ataxia following unspecified cerebrovascular disease N19, Unspecified kidney failure L23.3, Allergic contact dermatitis due to drugs in contact with skin L24.4, Irritant contact dermatitis due to drugs in contact with skin L25.1, Unspecified contact dermatitis due to drugs in contact with skin R27.8, Other lack of coordination R27.9, Unspecified lack of coordination T37.8X1A, Poisoning by other specified systemic anti-infectives and antiparasitics, accidental (unintentional), initial encounter T47.4X1A, Poisoning by other laxatives, accidental (unintentional), initial encounter T47.4X4A, Poisoning by other laxatives, undetermined, initial encounter T50.2X1A, Poisoning by carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, accidental (unintentional), initial encounter T49.8X1A, Poisoning by other topical agents, accidental (unintentional), initial encounter T56.1X1A, Toxic effect of mercury and its compounds, accidental (unintentional), initial encounter T60.3X1A, Toxic effect of herbicides and fungicides, accidental (unintentional), initial encounter T50.2X5A, Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, initial encounter |
Molybdenum84999 | Serum molybdenum testing is considered medically necessary for individuals with documented industrial exposure to molybdenum. | 985.8, Toxic effect Of other specified metals | T56.891A, Toxic effect of other metals, accidental (unintentional), initial encounter |
Nickel83885 | 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 Classified586, Renal Failure Unspecified985.8, Toxic Effect Of Other Specified MetalsE866.4, Accidental poisoning by other metals and their compounds and fumesV87.09, Contact with and (suspected) exposure to other hazardous metals | J98.4, Other disorders of lung N19, Unspecified renal failure T56.891A, Toxic effect of other metals, accidental (unintentional), initial encounter T56.91XA, Toxic effect of unspecified metal, accidental (unintentional), initial encounter Z77.018, Contact with and (suspected) exposure to other hazardous metals |
Selenium84255 | 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 Unspecified985.8, Toxic Effect Of Other Specified MetalsV45.11, Renal dialysis statusV45.12, Noncompliance with renal dialysis | N19, Unspecified renal failure T56.891A, Toxic effect of other metals, accidental (unintentional), initial encounter Z99.2, Dependence on renal dialysis Z91.15, Patient's noncompliance with renal dialysis |
Thallium84999 | 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 Agents781.3, Lack Of Coordination985.8, Toxic Effect Of Other Specified Metals | G62.2, Polyneuropathy due to other toxic agents R27.8, Other lack of coordination R27.9, Unspecified lack of coordination T56.811A, Toxic effect of thallium, accidental (unintentional), initial encounter |
Tin84999 | Serum tin testing is considered medically necessary for individuals with documented industrial exposure to tin. | 985.8, Toxic Effect Of Other Specified Metals | T56.6X1A, Toxic effect of tin and its compounds, accidental (unintentional), initial encounter |
Titanium84999 | Serum titanium testing is considered medically necessary for individuals with documented industrial exposure to titanium. | 985.8, Toxic Effect Of Other Specified Metals | T56.891A, Toxic effect of other metals, accidental (unintentional), initial encounter |
Zinc84630 | 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 Site579.9, Unspecified Intestinal Malabsorption586, Renal Failure Unspecified783.3, Feeding Difficulties And Mismanagement790.6, Other abnormal blood chemistry972.7, Poisoning by antivaricose drugs, including sclerosing agents chemistry985.8, Toxic Effect Of Other Specified MetalsE924.7, Antivaricose drugs, including sclerosing agents, causing adverse effect in therapeutic use | K50.90 - K50.919, Crohn's disease, unspecified code range K90.9, Intestinal malabsorption, unspecified N19, Unspecified kidney failure R63.30, R63.31, R63.32, R63.39, Feeding difficulties R79.0, Abnormal level of blood mineral T46.8X1A, Poisoning by antivaricose drugs, including sclerosing agents, accidental (unintentional), initial encounter T56.5X1A, Toxic effect of zinc and its compounds, accidental (unintentional), initial encounter T46.8X5A - T46.8X5S, Adverse effect of antivaricose drugs, including sclerosing agents |
None
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Medically Necessary is defined as those services, treatments, procedures, equipment, drugs, devices, items or supplies furnished by a covered Provider that are required to identify or treat a Member's illness, injury or Mental Health Disorders, and which Company determines are covered under this Benefit Plan based on the criteria as follows in A through D:
A. consistent with the symptoms or diagnosis and treatment of the Member's condition, illness, or injury; and
B. appropriate with regard to standards of good medical practice; and
C. not solely for the convenience of the Member, his or her Provider; and
D. the most appropriate supply or level of care which can safely be provided to Member. When applied to the care of an Inpatient, it further means that services for the Member's medical symptoms or conditions require that the services cannot be safely provided to the Member as an Outpatient.
For the definition of medical necessity, “standards of good medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
07/19/2012: Approved by Medical Policy Advisory Committee.
10/21/2013: Policy reviewed; no changes.
09/01/2015: Policy section updated for ICD-10.
02/26/2016: Policy section updated to add Z77.011 as a covered diagnosis for lead testing. Policy guidelines section updated to add medically necessary and investigative definitions.
03/29/2016: Policy section updated to add R78.71 as a covered diagnosis for lead testing.
04/19/2016: Policy section updated to add Z77.018 as a covered diagnosis for manganese testing.
06/07/2016: Policy number L.2.04.417 added.
09/08/2016: Policy section updated to make correction: ICD-10 diagnosis code G57.0 should be G57.90.
09/30/2016: Policy section updated to add the following new ICD-10 diagnosis codes: F32.89, F34.81, and F34.89.
09/26/2018: Code Reference section updated to add new ICD-10 diagnosis codes F12.23 and F12.93, effective 10/01/2018. Removed deleted ICD-10 diagnosis codes F32.8 and F34.8.
09/24/2020: Policy section updated to add new ICD-10 diagnosis codes N18.30, N18.31, N18.32, G11.10, and G11.19, effective 10/01/2020.
10/01/2021: Code Reference section updated to add new ICD-10 diagnosis codes R63.30, R63.31, R63.32, and R63.39 effective 10/01/2021.
11/08/2022: Policy reviewed. Policy statements unchanged. Policy Guidelines updated to change "Nervous/Mental Conditions" to "Mental Health Disorders" and "Medically Necessary" to "medical necessity."
10/18/2023: Policy reviewed. Policy statements unchanged. Removed deleted ICD-10 diagnosis codes R63.3 and G11.1.
12/05/2024: Policy reviewed; no changes.
10/01/2025: Code Reference section updated to add new ICD-10 diagnosis code Q89.89.
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.
Wisconsin Physicians Service Heavy Metal Testing Local Coverage Determination
This may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.
CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.