Gamma Glutamyl Transferase (GGT)

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1 Gamma Glutamyl Transferase (GGT) National Coverage Determination CPT Code: Numerical Sort: Salmonella septicemia Amebiasis Tuberculosis of intestines, peritoneum, and mesenteric glands Tuberculosis of other specified organs Miliary tuberculosis Plague Anthrax septicemia 27.1 Listeriosis 27.2 Erysipelothrix infection Tuberculoid leprosy (type T) Diphtheritic peritonitis 36.1 Meningococcal meningitis 36.2 Meningococcemia Septicemia Actinomycotic infections, abdominal Gas gangrene 042 Human immunodeficiency virus (HIV) disease Eczema herpeticum Herpetic septicemia Yellow fever Viral hepatitis Mumps hepatitis With pneumonia Other specified diseases due to Coxsackie virus 075 Infectious mononucleosis Cytomegaloviral disease Unspecified viral infection Tick-borne rickettsioses Other pernicious complications of malaria Chagas disease with other organ involvement Lyme disease Secondary syphilitic hepatitis Syphilis of liver Leptospirosis icterohemorrhagica Candidiasis, disseminated Infection by Histoplasma capsulatum; without mention of manifestation Schistosomiasis, unspecified Clonorchiasis Fascioliasis Echinococcus granulosus infection of liver Echinococcus multilocularis infection of liver Echinococcus, unspecified, of liver Echinococcus, other and unspecified Hepatitis; due to toxoplasmosis 135 Sarcoidosis Malignant neoplasm of esophagus Malignant neoplasm of respiratory and intrathoracic organs Malignant neoplasm of bone, connective tissue, skin, and breast Malignant neoplasm of genitourinary organs Malignant neoplasm of lymphatic and hematopoietic tissue Malignant carcinoid tumors of other and unspecified sites Tumors, neuroendocrine, secondary Benign neoplasm of liver and biliary passages January 2015 Medicare Limited Coverage Tests

2 211.6 Benign neoplasm of pancreas; except islets of Langerhans Benign neoplasm of islets of Langerhans Hemangioma of intra-abdominal structures Carcinoma in situ of other and unspecified parts of intestine Carcinoma in situ of liver and biliary system Carcinoma in situ of other and unspecified digestive organs Neoplasm of uncertain behavior of digestive and respiratory systems Neoplasm of uspecified nature of digestive system Diabetes mellitus Hyperparathyroidism Malnutrition of moderate degree Unspecified protein-calorie malnutrition Rickets, active Osteomalacia, unspecified Deficiency of vitamin K Other disturbances of aromatic amino-acid metabolism Unspecified disorder of amino-acid metabolism Glycogenosis Pure hypercholesterolemia Pure hyperglyceridemia Mixed hyperlipidemia Other and unspecified hyperlipidemia Lipidoses Unspecified disorder of lipoid metabolism Alpha-1-deficiency Disorders of iron metabolism Disorders of copper metabolism Disorders of magnesium metabolism Disorders of phosphorus metabolism Disorders of calcium metabolism Syndrome, hungry bone Disorders of porphyrin metabolism Amyloidosis Disorders of bilirubin excretion Other deficiencies of circulating enzymes Sickle-cell anemia Defibrination syndrome Acquired coagulation factor deficiency Hypersplenism Splenic sequestration Alcoholic psychoses Acute alcoholic intoxication Other and unspecified alcohol dependence Drug dependence Nondependent abuse of drugs Alcoholic polyneuropathy Disorders, Myotonic 452 Portal vein thrombosis Embolism, venous acute, of deep vessels Embolism, venous, chronic, of deep vessels of lower extremity Embolism, venous, embolism and thrombosis of superficial vessels of lower extremity Embolism, venous embolism and thrombosis of other specified vessels of lower extremity Embolism, venous, embolism and thrombosis of other specified veins Varicose veins of other sites Regional enteritis Ulcerative colitis Acute vascular insufficiency of intestine Other and unspecified noninfectious gastroenteritis and colitis Intestinal obstruction without mention of hernia Medicare Limited Coverage Tests January 2015

3 Diverticulitis of small intestine (without mention of hemorrhage) Diverticulitis of small intestine with hemorrhage Diverticulitis of colon (without mention of hemorrhage) Diverticulitis of colon with hemorrhage Perforation of intestine Vomiting of fecal matter 570 Acute and subacute necrosis of liver Chronic liver disease and cirrhosis Liver abscess and sequelae of chronic liver disease Other disorders of liver Cholelithiasis Other disorders of gallbladder Other disorders of biliary tract Nephrotic syndrome Chronic glomerulonephritis Nephritis and nephropathy, not specified as acute or chronic Acute renal failure End stage renal disease 586 Renal failure, unspecified 587 Renal sclerosis, unspecified Disorders resulting from impaired renal function Infections of kidney Severe pre-eclampsia Liver disorders in pregnancy Jaundice, unspecified, not of newborn Hepatomegaly Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase (LDH) Other nonspecific abnormal serum enzyme levels Poisoning by drugs, medicinal and biological substances Toxic effects of substances chiefly nonmedicinal to source V42.7 Organ or tissue replaced by transplant, liver V58.61-V58.64 Long-term (current) drug use, anticoagulants, antibiotics, antiplatelets,non-steroidal anti-inflammatories V58.69 Long-term (current) drug use, of other medications V67.1 Following radiotherapy V67.2 Following chemotherapy V67.51 Following completed treatment with high-risk mediciations, not elsewhere classified Medicare Limited Coverage Tests Covered Diagnosis Codes Source: National Coverage Determinations January 2013 Coding Policy Manual and Change Report January 2015 Medicare Limited Coverage Tests

4 Gamma Glutamyl Transferase (GGT), Continued Alphabetical Sort: Abnormal; serum level, other nonspecific abnormal serum enzyme levels Abscess; liver abscess and sequelae of chronic liver disease Abuse; nondependent abuse of drugs Actinomycosis; Abdominal Alcohol; acute alcoholic intoxication Alcohol; alcoholic psychoses Alcohol; other and unspecified alcohol dependence Amebiasis Amyloidosis Anthrax septicemia Candidiasis; disseminated Cholangitis; other disorders of biliary tract Cholelithiasis Cirrhosis; Chronic liver disease and cirrhosis Clonorchiasis Colitis; ulcerative colitis Coxsackie; other specified diseases due to Coxsackie virus Cytomegalic, inclusion disease, Cytomegaloviral disease Defibrination syndrome Deficiency of vitamin K Deficiency; acquired coagulation factor deficiency Deficiency; other deficiencies of circulating enzymes Dependence; drug Diabetes; complication, diabetes mellitus Diphtheritic peritonitis Disorder: Alpha-1-deficency Disease; other disorders of liver Disease, renal, end stage Disorder; amino acid, oasthouse urine disease, other disturbances of aromatic aminoacid metabolism Disorder; lipid, unspecified disorder of lipoid metabolism Disorders of bilirubin excretion Disorders of calcium metabolism Disorders of copper metabolism Disorders of iron metabolism Disorders of magnesium metabolism Disorders, myotonic Disorders of phosphorus metabolism Disorders of porphyrin metabolism Disorders resulting from impaired renal function Disturbances; unspecified disorder of amino-acid metabolism Diverticulitis of colon (without mention of hemorrhage) Diverticulitis of colon with hemorrhage Diverticulitis of small intestine (without mention of hemorrhage) Diverticulitis of small intestine with hemorrhage Echinococcus granulosus infection of liver Echinococcus multilocularis infection of liver Echinococcus, other and unspecified Echinococcus, unspecified, of liver Eczema herpeticum Embolism, venous acute, of deep vessels Embolism, venous, chronic of deep vessels of lower extremity Embolism, venous, embolism and thrombosis of other specified veins Embolism, venous embolism and thrombosis of other specified vessels of lower extremity Medicare Limited Coverage Tests January 2015

5 453.6 Embolism, venous, embolism and thrombosis of superficial vessels of lower extremity Enteritis; regional enteritis Erysipelatoid; erysipelothrix infection Failure; acute renal failure 586 Failure; renal failure, unspecified Fascioliasis Fever; yellow fever Findings, abnormal, without diagnosis; nonspecific elevation of levels of transaminase or lactic acid dehydrogenase (LDH) V67.2 Follow-up; following chemotherapy V67.51 Follow-up; following completed treatment with high-risk medications, not elsewhere classified V67.1 Follow-up; following radiotherapy Gangrene; other disorders of gallbladder Gas gangrene Gastroenteritis; other and unspecified noninfectious gastroenteritis and colitis Glomerulonephritis; chronic Glycogenosis Hemagioma; peritoneum, of intra-abdominal structures Hepatitis; secondary syphilitic hepatitis Hepatitis; viral hepatitis Hepatomegaly 042 Human immunodeficiency virus (HIV) disease Hypercholesterolemia, Pure Hyperglyceridemia; Pure Hyperlipidemia; mixed Hyperlipidemia; other and unspecified hyperlipidemia Hyperparathyroidism Hypersplenism Infection; histoplasma capsulatum; without mention of manifestation Infection; toxoplasmosis hepatitis due to toxoplasmosis Infection; unspecified viral infection Infections of kidney Jaundice; unspecified, not of newborn Leprosy; tuberculoid (type T) Leptospirosis icterohemorrhagica Lipidoses Listeriosis V58.61-V58.64 Long-term (current) drug use, anticoagulants, antibiotics, antiplatelets,non-steroidal anti-inflammatories V58.69 Long-term (current) drug use, of other medications Lyme disease Malaria; other pernicious complications of malaria Malnutrition of moderate degree Malnutrition; unspecified protein-calorie malnutrition 36.1 Meningitis; meningococcal meningitis 36.2 Meningococcemia 075 Mononucleosis; infectious mononucleosis Mumps hepatitis 570 Necrosis; liver, acute and subacute necrosis of liver Neoplasm; benign, langerhans, Islets of Langerhans Neoplasm; benign, liver and biliary passages Neoplasm; benign, pancreas, except islets of Langerhans Neoplasm; Ca in situ, alimentary canal, other and unspecified digestive organs Neoplasm; Ca in situ, anorectum, Other and unspecified parts of intestine Neoplasm; Ca in situ, liver and biliary system Neoplasm; malignant neoplasm of bone, connective tissue, skin, and breast Neoplasm; malignant neoplasm of esophagus Neoplasm; malignant neoplasm of genitourinary organs January 2015 Medicare Limited Coverage Tests

6 Neoplasm; malignant neoplasm of lymphatic and hematopoietic tissue Neoplasm; malignant neoplasm of respiratory and intrathoracic organs Neoplasm; uncertain behavior of digestive and respire-atory systems Neoplasm; uncertain behavior, digestive system Nephritis and nephropathy, not specified as acute or chronic Nephritis; nephrotic syndrome Obstruction; intestinal obstruction without mention of hernia Ornithosi; pneumonia, with pneumonia Osteomalacia, unspecified Perforation of intestine Plague Poisoning by drugs, medicinal and biological substances (See Table of Drugs and Chemicals; poisoning) Polyneuropathy; alcoholic Pregnancy; liver disorders in pregnancy Pregnancy; severe pre-eclampsia Rickets, active Salmonella septicemia 135 Sarcoidosis Schistosomiasis, unspecified 587 Sclerosis; renal sclerosis, unspecified Septicemia Septicemia; herpetic septicemia Sickle-cell anemia Splenic sequestration Syndrome, hungry bone Syndrome; vascular splanchnic, acute vascular insufficiency of intestine Syphilis of liver 452 Thrombosis; portal vein thrombosis Tick-borne rickettsioses Toxic effects of substances chiefly nonmedicinal to source (See Table of Drugs and Chemicals; poisoning) V42.7 Transplant; organ or tissue replaced by transplant, liver Trypanosomiasis; Chagas disease with other organ involvement Tuberculosis; intestines, peritoneum, and mesenteric glands Tuberculosis; military tuberculosis Tuberculosis; other specified organs Tumor, carcinoid, malignant, of other and unspecified sites Tumors, neuroendocrine, secondary Varicose veins of other sites Vomiting of fecal matter Medicare Limited Coverage Tests Covered Diagnosis Codes Source: National Coverage Determinations January 2013 Coding Policy Manual and Change Report Medicare Limited Coverage Tests January 2015

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