(Reproduced by permission from Medicare Focus, August, 1998, pp. 9 - 15.)
Thyroid function studies are used to delineate the presence or absence of hormonal abnormalities of the thyroid. These abnormalities may be either primary or secondary and usually accompany clinically well defined signs and symptoms indicative of thyroid dysfunction.
Serum levels of thyroid hormone are useful to confirm clinical hyperfunction, hypofunction or euthyroidism of the thyroid gland. Thyroid function levels do not determine the etiology of thyroid disease.
Laboratory analysis to detect thyroid function has become more scientifically defined. Tests can be done with increased specificity, thereby reducing the number of tests needed to diagnose and follow treatment of most thyroid disease. The American Thyroid Association recommends the measurement of serum sensitive thyroid-stimulating hormone (sTSH) levels complemented by an appropriate free thyroxine (FT4) estimate. These tests represent the best and most efficient combination of blood tests for diagnosis and follow-up of most patients with thyroid disorders. This is true for most ambulatory patients. It is not meant to be used for certain complex diagnostic problems or on an inpatient basis, where many circumstances can skew test results.
Type of Bill
12X, 13X, 14X, 22X, 23X, 71X, 74X, 75X,
300 - 319
Indications and Limitations
Thyroid function levels do not determine the etiology of thyroid disease but are necessary to define hyperfunction, euthyroidism, or hypofunction of thyroid disease. Screening testing using thyroid function tests is excluded from Medicare coverage by statutory exclusion.
Thyroid testing is used to:
Distinguish between primary and secondary hypothyroidism;
Confirm or rule out primary hypothyroidism;
Monitor drug therapy in patients with primary hypothyroidism, and;
Confirm or rule out primary hyperthyroidism.
Thyroid stimulating hormone (TSH)
Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR)
Thyroid panel, includes Thyroxine; total (84436) and thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR) (84479).
Thyroid panel with thyroid stimulating hormone (TSH) (84443) and includes (84436, 84479).
Diagnosis Codes For Coverage
One of the following covered ICD-9-CM diagnosis code(s) must be linked to the appropriate procedure.
Other Diseases Due to Viruses and Chlamydiae
Malignant Neoplasm of Other and Unspecified Sites
Carcinoma in Situ
Neoplasms of Uncertain Behavior
Neoplasms of Unspecified Nature
Disorders of Thyroid Gland
Diseases of Other Endocrine Glands
Other Metabolic and Immunity Disorders
275.40-275.49 Revised per Medicare Focus January, 2001
Diseases of the Blood and Blood-Forming Organs
281.0 Revised per Medicare Focus April, 2001
Organic Psychotic Conditions
Neurotic Disorders, Personality Disorders, and Other Nonpsychotic Mental Disorders
Hereditary and Degenerative Diseases of the Central Nervous System
Other Diseases of the Central Nervous System
Disorders of the Peripheral Nervous System
Disorders of the Eye and Adnexa
Other Forms of Heart Disease
Other Diseases of Intestines and Peritoneum
564.0-564.9 Revised per Medicare Focus December, 2001
Other Disorders of Female Genital Tract
Complications Mainly Related to Pregnancy
Complications of the Puerperium
Other Diseases of Skin and Subcutaneous Tissue
Arthropathies and Related Disorders
710.9 Revised per Medicare Focus April, 2001
712.10 - 712.39 Revised per Medicare Focus April, 2001
716.90 - 716.99 Revised per Medicare Focus April, 2001
Rheumatism, Excluding the Back
725 Revised per Medicare Focus April, 2001
729.0 Revised per Medicare Focus April, 2001
Osteopathies, Chondropathies, and Acquired Musculoskeletal Deformities
733.00 Revised per Medicare Focus April, 2001
Other Conditions Originating in the Perinatal Period
780.71-780.79 Revised per Medicare Focus September, 1999
783.21 Revised per Medicare Focus December, 2000
Nonspecific Abnormal Findings
Ill-Defined and Unknown Causes of Morbidity and Mortality
Other and Unspecified Effects of External Causes
Persons Encountering Health Services for Specific Procedures and Aftercare
Pathology and Laboratory
HCFA National Policy
Title XVIII of the Social Security Act, section 1862 (a) (7). This section excludes routine physical examinations.
Title XVIII of the Social Security Act, section 1862 (a) (1) (A). This section allows coverage and payment for only those services that are considered to be medically reasonable and necessary.
Reason For Denial
When the test is considered to be medically unnecessary
When performed as a screening test, which is statutorily excluded by Medicare
Non-Covered Diagnosis Codes
Any that are not listed as covered diagnosis codes in the "Diagnosis Codes for Coverage" section in this policy.
Sources of Information
The American Thyroid Association
Common Diagnosis Tests, Use and Interpretation
The Merck Manual
CMD Clinical Laboratory Workgroup
ICD-9 code V82.9, (special screening of other conditions, unspecified condition), or comparable narratives should be used to indicate screening tests performed in the absence of a specific sign, symptom, or complaint. Use of V82.9 or comparable narrative will result in the denial of claims as non covered screening services.
Only the test or combination of tests which best addresses the clinical thyroid condition will be covered. Following are examples of which test or possible combination of tests would be indicated:
84436 (T4) and/or 84439 (freeT4)
84436 (T4) and/or 84443 (TSH)
Thyroid binding abnormality:
80091 (thyroid panel, including T4 total and T3 Resin Uptake) or 80092 (thyroid panel, including T4 total, T3 Resin Uptake, and TSH)
If procedure code 84436 (thyroxine, total) and 84479 (Thyroid hormone T3 or T4 or Thyroidbinding Ratio), resin uptake are performed on the same day of service as 80091, the individual components will be combined and paid as code 80091.4
If procedure codes 84436, 84479, and 84443 (TSH) are performed on the same day of service as 80092, the individual components will be combined and paid code 80092.
The claim must be submitted with one of the covered ICD-9 diagnosis codes. Failure to do so may result in denial or delay in processing the claim.
Reconsiderations and Appeals - Claims resubmitted with a different diagnosis code must include medical record documentation to justify the diagnosis code change. Submission with diagnoses other than those listed as "Covered Codes" will be individually reviewed by this Intermediary for medical necessity.
ICD-9-CM diagnosis codes are required on claim.
Medical Records must clearly document the medical necessity for the test and the frequency of the test.
If documentation is requested for review, submit the following:
History and Physical
Physician orders/progress notes
Diagnosis/reason for test
Itemization of charges
This policy is a revision of and supersedes all previously published thyroid policies (96-14, 96-15, 96-16, 96-17, 97-13) and is being republished for diagnosis clarification purposes.
This policy should be interpreted to incorporate future changes in the ICD-9 -CM or CPT/HCPCS coding systems such that its original intent and scope will not be substantively changed.
Date of Notice and Comments:
Notice Period Date:
October 1996 Revision: July 1, 1997
Effective Date of Policy:
November 1, 1996
Revised Effective Date:
August 1, 1997 (97-13)
This policy does not reflect the sole opinion of the Intermediary/Medical Director.