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| LCD Information |
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| LCD ID Number back to top |
| L10158 |
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| LCD Title back to top |
| Serum Phosphorus |
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| Contractor's Determination Number back to top |
| 01A-0003-L |
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| AMA CPT / ADA CDT Copyright Statement back to top |
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CPT codes, descriptions and other data only are copyright
2009 American Medical Association (or such other date of publication of CPT).
All Rights Reserved. Applicable FARS/DFARS Clauses Apply.
Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
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| CMS National Coverage Policy back to top |
Title XVIII of the Social Security Act, §1862 (a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
Title XVIII of the Social Security Act, §1862(a)(7) excludes routine physical examinations.
CMS Manual System, Pub 100-02, Medicare Benefit Policy Manual, Chapter 11, §20
CMS Manual System, Pub 100-08, Medicare Program Integrity, Transmittal 63, dated January 23, 2004, Change Request 3010 |
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| Primary Geographic Jurisdiction back to top |
South Carolina
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| Oversight Region back to top |
Region IV
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| Original Determination Effective Date back to top |
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For services performed on or after
08/01/2001
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| Original Determination Ending Date back to top |
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| Revision Effective Date back to top |
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For services performed on or after
10/01/2008
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| Revision Ending Date back to top |
| 09/30/2009 |
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| Indications and Limitations of Coverage and/or Medical Necessity back to top |
Disorders of phosphorus homeostasis may be related to many pathological conditions. Serum phosphorus levels help to characterize disorders involving specific systems (e.g., endocrine and renal) as well as more generalized disorders such as malnutrition and sepsis.
Palmetto GBA will consider serum phosphorus reasonable and necessary under either of the two following circumstances:
1. Evaluation of patients with signs and symptoms of hypophosphatemia
2. Evaluation of patients with signs and symptoms of hyperphosphatemia
A serum phosphorus determination may be performed as part of an organ or disease oriented panel. This policy does not apply to serum phosphorus determinations performed as part of an organ/disease panel. |
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| Coding Information |
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Bill Type Codes: back to top
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. |
| 12x |
Hospital-inpatient or home health visits (Part B only) |
| 13x |
Hospital-outpatient (HHA-A also) (under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00) |
| 14x |
Non-Patient Laboratory Specimens |
| 18x |
Hospital-swing beds |
| 21x |
SNF-inpatient, Part A |
| 22x |
SNF-inpatient or home health visits (Part B only) |
| 23x |
SNF-outpatient (HHA-A also) |
| 71x |
Clinic-rural health |
| 72x |
Clinic-hospital based or independent renal dialysis facility |
| 73x |
Clinic-independent provider based FQHC (eff 10/91) |
| 85x |
Special facility or ASC surgery-rural primary care hospital (eff 10/94) |
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Revenue Codes: back to top
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes. |
| 030X |
Laboratory-general classification |
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| CPT/HCPCS Codes back to top |
| 84100 |
PHOSPHORUS INORGANIC (PHOSPHATE); |
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| ICD-9 Codes that Support Medical Necessity back to top |
| 038.0 |
STREPTOCOCCAL SEPTICEMIA |
| 038.10 |
STAPHYLOCOCCAL SEPTICEMIA UNSPECIFIED |
| 038.11 |
METHICILLIN SUSCEPTIBLE STAPHYLOCOCCUS AUREUS SEPTICEMIA |
| 038.12 |
METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS SEPTICEMIA |
| 038.19 |
OTHER STAPHYLOCOCCAL SEPTICEMIA |
| 038.2 |
PNEUMOCOCCAL SEPTICEMIA |
| 038.3 |
SEPTICEMIA DUE TO ANAEROBES |
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038.40 - 038.49
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SEPTICEMIA DUE TO GRAM-NEGATIVE ORGANISM UNSPECIFIED - OTHER SEPTICEMIA DUE TO GRAM-NEGATIVE ORGANISMS |
| 038.8 |
OTHER SPECIFIED SEPTICEMIAS |
| 038.9 |
UNSPECIFIED SEPTICEMIA |
| 135 |
SARCOIDOSIS |
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170.0 - 170.9
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MALIGNANT NEOPLASM OF BONES OF SKULL AND FACE EXCEPT MANDIBLE - MALIGNANT NEOPLASM OF BONE AND ARTICULAR CARTILAGE SITE UNSPECIFIED |
| 198.5 |
SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE MARROW |
| 203.00 |
MULTIPLE MYELOMA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION |
| 203.01 |
MULTIPLE MYELOMA IN REMISSION |
| 203.02 |
MULTIPLE MYELOMA, IN RELAPSE |
| 203.10 |
PLASMA CELL LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION |
| 203.11 |
PLASMA CELL LEUKEMIA IN REMISSION |
| 203.12 |
PLASMA CELL LEUKEMIA, IN RELAPSE |
| 203.80 |
OTHER IMMUNOPROLIFERATIVE NEOPLASMS, WITHOUT MENTION OF HAVING ACHIEVED REMISSION |
| 203.81 |
OTHER IMMUNOPROLIFERATIVE NEOPLASMS IN REMISSION |
| 203.82 |
OTHER IMMUNOPROLIFERATIVE NEOPLASMS, IN RELAPSE |
| 205.00 |
ACUTE MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION |
| 205.01 |
MYELOID LEUKEMIA ACUTE IN REMISSION |
| 205.02 |
ACUTE MYELOID LEUKEMIA, IN RELAPSE |
| 205.10 |
CHRONIC MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION |
| 205.11 |
MYELOID LEUKEMIA CHRONIC IN REMISSION |
| 205.12 |
CHRONIC MYELOID LEUKEMIA, IN RELAPSE |
| 205.20 |
SUBACUTE MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION |
| 205.21 |
MYELOID LEUKEMIA SUBACUTE IN REMISSION |
| 205.22 |
SUBACUTE MYELOID LEUKEMIA, IN RELAPSE |
| 205.30 |
MYELOID SARCOMA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION |
| 205.31 |
MYELOID SARCOMA IN REMISSION |
| 205.32 |
MYELOID SARCOMA, IN RELAPSE |
| 205.80 |
OTHER MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION |
| 205.81 |
OTHER MYELOID LEUKEMIA IN REMISSION |
| 205.82 |
OTHER MYELOID LEUKEMIA, IN RELAPSE |
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205.90 - 205.91
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UNSPECIFIED MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED MYELOID LEUKEMIA IN REMISSION |
| 205.92 |
UNSPECIFIED MYELOID LEUKEMIA, IN RELAPSE |
| 238.6 |
NEOPLASM OF UNCERTAIN BEHAVIOR OF PLASMA CELLS |
| 238.77 |
POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDER (PTLD) |
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242.00 - 242.91
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TOXIC DIFFUSE GOITER WITHOUT THYROTOXIC CRISIS OR STORM - THYROTOXICOSIS WITHOUT GOITER OR OTHER CAUSE WITH THYROTOXIC CRISIS OR STORM |
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250.10 - 250.13
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DIABETES WITH KETOACIDOSIS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED - DIABETES WITH KETOACIDOSIS, TYPE I [JUVENILE TYPE], UNCONTROLLED |
| 252.00 |
HYPERPARATHYROIDISM, UNSPECIFIED |
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252.01 - 252.08
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PRIMARY HYPERPARATHYROIDISM - OTHER HYPERPARATHYROIDISM |
| 252.1 |
HYPOPARATHYROIDISM |
| 253.0 |
ACROMEGALY AND GIGANTISM |
| 255.0 |
CUSHING'S SYNDROME |
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260 - 263.9
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KWASHIORKOR - UNSPECIFIED PROTEIN-CALORIE MALNUTRITION |
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268.0 - 268.9
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RICKETS ACTIVE - UNSPECIFIED VITAMIN D DEFICIENCY |
| 275.2 |
DISORDERS OF MAGNESIUM METABOLISM |
| 275.3 |
DISORDERS OF PHOSPHORUS METABOLISM |
| 275.40 |
UNSPECIFIED DISORDER OF CALCIUM METABOLISM |
| 275.41 |
HYPOCALCEMIA |
| 275.42 |
HYPERCALCEMIA |
| 275.5 |
HUNGRY BONE SYNDROME |
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276.0 - 276.9
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HYPEROSMOLALITY AND/OR HYPERNATREMIA - ELECTROLYTE AND FLUID DISORDERS NOT ELSEWHERE CLASSIFIED |
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277.30 - 277.39
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AMYLOIDOSIS, UNSPECIFIED - OTHER AMYLOIDOSIS |
| 278.4 |
HYPERVITAMINOSIS D |
| 278.8 |
OTHER HYPERALIMENTATION |
| 282.60 |
SICKLE-CELL DISEASE UNSPECIFIED |
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287.0 - 287.9
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ALLERGIC PURPURA - UNSPECIFIED HEMORRHAGIC CONDITIONS |
| 293.0 |
DELIRIUM DUE TO CONDITIONS CLASSIFIED ELSEWHERE |
| 293.1 |
SUBACUTE DELIRIUM |
| 298.9 |
UNSPECIFIED PSYCHOSIS |
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303.00 - 303.03
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ACUTE ALCOHOLIC INTOXICATION IN ALCOHOLISM UNSPECIFIED DRINKING BEHAVIOR - ACUTE ALCOHOLIC INTOXICATION IN ALCOHOLISM IN REMISSION |
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303.90 - 303.93
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OTHER AND UNSPECIFIED ALCOHOL DEPENDENCE UNSPECIFIED DRINKING BEHAVIOR - OTHER AND UNSPECIFIED ALCOHOL DEPENDENCE IN REMISSION |
| 305.00 |
NONDEPENDENT ALCOHOL ABUSE UNSPECIFIED DRINKING BEHAVIOR |
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305.01 - 305.03
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NONDEPENDENT ALCOHOL ABUSE CONTINUOUS DRINKING BEHAVIOR - NONDEPENDENT ALCOHOL ABUSE IN REMISSION |
| 348.30 |
ENCEPHALOPATHY UNSPECIFIED |
| 348.31 |
METABOLIC ENCEPHALOPATHY |
| 348.39 |
OTHER ENCEPHALOPATHY |
| 403.11 |
HYPERTENSIVE CHRONIC KIDNEY DISEASE, BENIGN, WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE |
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579.0 - 579.9
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CELIAC DISEASE - UNSPECIFIED INTESTINAL MALABSORPTION |
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580.0 - 588.9
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ACUTE GLOMERULONEPHRITIS WITH LESION OF PROLIFERATIVE GLOMERULONEPHRITIS - UNSPECIFIED DISORDER RESULTING FROM IMPAIRED RENAL FUNCTION |
| 728.88 |
RHABDOMYOLYSIS |
| 728.89 |
OTHER DISORDERS OF MUSCLE LIGAMENT AND FASCIA |
| 728.9 |
UNSPECIFIED DISORDER OF MUSCLE LIGAMENT AND FASCIA |
| 729.1 |
MYALGIA AND MYOSITIS UNSPECIFIED |
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729.71 - 729.79
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NONTRAUMATIC COMPARTMENT SYNDROME OF UPPER EXTREMITY - NONTRAUMATIC COMPARTMENT SYNDROME OF OTHER SITES |
| 731.0 |
OSTEITIS DEFORMANS WITHOUT BONE TUMOR |
| 731.3 |
MAJOR OSSEOUS DEFECTS |
| 733.00 |
OSTEOPOROSIS UNSPECIFIED |
| 733.90 |
DISORDER OF BONE AND CARTILAGE UNSPECIFIED |
| 733.96 |
STRESS FRACTURE OF FEMORAL NECK |
| 733.97 |
STRESS FRACTURE OF SHAFT OF FEMUR |
| 733.98 |
STRESS FRACTURE OF PELVIS |
| 753.9 |
UNSPECIFIED CONGENITAL ANOMALY OF URINARY SYSTEM |
| 780.32 |
COMPLEX FEBRILE CONVULSIONS |
| 780.39 |
OTHER CONVULSIONS |
| 780.97 |
ALTERED MENTAL STATUS |
| 782.0 |
DISTURBANCE OF SKIN SENSATION |
| 783.0 |
ANOREXIA |
| 787.02 |
NAUSEA ALONE |
| 790.6 |
OTHER ABNORMAL BLOOD CHEMISTRY |
| 790.7 |
BACTEREMIA |
| 793.0 |
NONSPECIFIC ABNORMAL FINDINGS ON RADIOLOGICAL AND OTHER EXAMINATION OF SKULL AND HEAD |
| 793.7 |
NONSPECIFIC ABNORMAL FINDINGS ON RADIOLOGICAL AND OTHER EXAMINATION OF MUSCULOSKELETAL SYSTEM |
| 799.2 |
NERVOUSNESS |
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958.90 - 958.99
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COMPARTMENT SYNDROME, UNSPECIFIED - TRAUMATIC COMPARTMENT SYNDROME OF OTHER SITES |
| 965.1 |
POISONING BY SALICYLATES |
| 990 |
EFFECTS OF RADIATION UNSPECIFIED |
| V45.89 |
OTHER POSTSURGICAL STATUS |
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| Diagnoses that Support Medical Necessity back to top |
| N/A |
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| ICD-9 Codes that DO NOT Support Medical Necessity back to top |
N/A
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| ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation back to top |
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| Diagnoses that DO NOT Support Medical Necessity back to top |
| N/A |
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| General Information |
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| Documentation Requirements back to top |
If the provider of the service is other than the ordering /referring physician, that provider must maintain documentation of the test results and interpretation, along with copies of the physician 's order for the test. The physician must document the clinical indication for the test on the order.
Documentation supporting the medical necessity should be legible, maintained in the patient’s medical record, and must be made available to the Intermediary upon request. |
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| Appendices back to top |
| N/A |
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| Utilization Guidelines back to top |
| N/A |
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| Sources of Information and Basis for Decision back to top |
Fauci AS, Braunwald E, Isselbacher KJ, et al. Harrison’s Principles of Internal Medicine. 14th ed. 1998.
Wallach JB. Interpretation of Diagnostic Tests.7th ed. 2000. |
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| Advisory Committee Meeting Notes back to top |
| This policy does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the Intermediary, this policy was developed in cooperation with advisory groups, which include representatives from the affected provider community. Advisory Committee Meeting Date: 04/02/2001. |
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| Start Date of Comment Period back to top |
| 03/09/2001 |
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| End Date of Comment Period back to top |
| 04/24/2001 |
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| Start Date of Notice Period back to top |
| 06/15/2001 |
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| Revision History Number back to top |
Revision #16, 10/01/2008
Revision #15, 12/28/2007
Revision #14, 11/01/2006
Revision #13, 10/01/2006
Revision #12, 02/23/2006
Revision #11, 10/01/2005
Revision #10, 04/15/2005
Revision #9, 03/31/2005
Revision #8, 12/21/2004
Revision #7, 11/22/2004
Revision #6, 10/01/2004
Revision #5, 11/28/2003
Revision #4, 11/01/2003
Revision #3, 10/01/2003
Revision #2, 10/01/2002
Revision #1, 04/01/2002 |
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| Revision History Explanation back to top |
Revision #16, 10/01/2008
Under AMA/CPT & ADA/CDT Copyright Statement section the copyright date was changed from 2007 to 2008. Under ICD-9 Codes That Support Medical Necessity the following ICD-9 codes were added: 038.12, 203.02, 203.10, 203.11, 203.12, 203.80, 203.81, 203.82, 205.02, 205.12, 205.22, 205.32, 205.82, 205.92, 238.77, 275.5, 733.96, 733.97 and 733.98. This revision becomes effective on 10/0/2008.
Revision #15, 12/28/2007
Under AMA/CPT &ADA/CDT Copyright Statement the copyright date was changed from 2006 to 2007. Under CMS National Coverage Policy the publication numbers for the cited manual references were changed from “100-2” and “100-8” to now read “100-02” and “100-08”. Under Revision History the revision history date was changed in accordance with the revision verbiage from 09/17/2002 to now read 10/01/2002. This policy was reviewed for annual validation. This revision becomes effective 12/28/2007.
Revision #14, 11/01/2006
Under Revision History #13 corrected a typographical error for the ICD-9 code range 958.90-959.99 to now read 958.90-958.99. This revision becomes effective 11/01/2006.
Revision #13, 10/01/2006
Under AMA/CPT & ADA/CDT Copyright Statement the copyright date was changed from 2005 to 2006. Under ICD-9 Codes That Support Medical Necessity added ICD-9 codes 277.30-277.39, 729.71-729.79, 731.3, 780.32, 780.97 and 958.90-958.99. Revised the verbiage for ICD-9 code 403.11. This policy was reviewed for annual validation. This revision becomes effective 10/01/2006.
Revision #12, 02/23/2006
Under CMS National Coverage Policy verbiage changed for Title XVIII of the Social Security Act, section 1862 (a)(7). Under Advisory Committee Meeting Notes changed “affective” to read “affected” and added “Advisory” to Committee Meeting Date. This revision becomes effective 02/23/2006.
Revision #11, 10/01/2005
Under AMA/CPT & ADA/CDT Copyright Statement the copyright date was changed from 2004 to 2005. Under CMS National Coverage Policy section the following two citations were added:
Title XVIII of the Social Security Act, section 1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
Title XVIII of the Social Security Act, section 1862(a)(7) excludes routine physical examinations
The following citation was deleted as it is no longer applicable:
CMS Manual System, Pub. 100-3, National Coverage Determinations Manual, Chapter 1, Part 3, Section 190.1.
Under Bill Type Codes section bill type 73x was added. Under Documentation Requirements section #2 was change to read, “Documentation supporting the medical necessity should be legible, maintained in the patient’s medical record, and must be made available to the Intermediary upon request. These changes become effective on 10/01/2005.
Revision #10, 04/15/2005
Under ICD-9 Codes That Support Medical Necessity added ICD-9 codes 275.41 and 275.42 and revised descriptions of ICD-9 codes 238.6, 403.11, 793.0 and 793.7. This revision becomes effective 04/15/2005.
Revision #9, 03/31/2005
Converted the LMRP to a LCD. This change becomes effective 03/17/2005.
Under CMS National Coverage Policy added Change Request 3010 and NCD citation. Under Indications ans Limitations of Coverage and/or Medical Necessity added, “A serum phosphorus determination may be performed…” Under ICD-9 Codes That Support Medical Necessity added ICD-9 codes 038.0 and 305.00. These changes become effective 03/31/2005.
Revision #8, 12/21/2004
Under ICD-9 Codes That Support Medical Necessity section of the policy, add ICD-9 code 733.00. This change becomes effective 12/21/2004.
Revision #7,11/22/2004
Under the AMA CPT Copyright Statement section of this policy, deleted the reference to CDT-4 copyright language, as this policy does not contain CDT-4 codes or descriptions. This revision becomes effective 11/22/2004.
Revision #6, 10/01/2004
Under the AMA CPT Copyright Statement section of this policy the copyright date has been changed from 2003 to 2004. Added the American Dental Association copyright statement. Under ICD-9 Codes That Support Medical Necessity section of the policy extended ICD-9 code 252.0 to 252.00. Added ICD-9 codes 252.01-252.08 and 403.11. Deleted the 4th digit of ICD-9 code 260.0 to now read 260. Verbiage change to ICD-9 code 293.0-293.1. These changes become effective 10/01/2004.
Revision #5 11/28/2003
Under CMS National Coverage Policy section of this policy the manual citation has been changed to reflect the Internet Only Manual (IOM). This change becomes effective 11/28/2003.
Revision #4, 11/01/2003
Under ICD-9 Codes That Support Medical Necessity section of this policy ICD-9 code 303.0 has been expanded to 303.01-303.03, 303.9 has been expanded to 303.90-303.93, 305.0 has been expanded to 305.1-305.3 and 731 has been changed to 731.0. These change become effective 11/01/2003.
Revision #3 10/01/2003
Under the AMA CPT Copyright Statement section of this policy the copyright date has been changed from 2002-2003. Under the ICD-9 Codes That Support Medical Necessity section of this policy ICD-9 code 038-0389 has been changed to 038.10-038.9, 250.1 has been changed to 250.10-250.13, 349.3 has been changed to 348.30 and 728.89 has been changed to 728.88 (Rhabdomyolysis). ICD-9 282.60 had a verbiage change to Sickle Cell Anemia; unspecified. These changes become effective 10/01/2003.
Revision #2 10/01/2002
Under Type of Bill Code section, Critical Access Hospital (85x) has been added. This change becomes effective 10/01/2002.
Revision #1 04/01/2002
Verbiage under Indications and Limitations of Coverage and/or Medical Necessity section and the Coding Guidelines section has been changed to state that this policy applies to scenarios when and individual serum phosphorus test is ordered.
This LCD was converted from an LMRP on 3/16/2005
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| Reason for Change back to top |
Maintenance (annual review with new changes, formatting, etc.)
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| Last Reviewed On Date back to top |
| 09/18/2008 |
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| Related Documents back to top |
Article(s)
A35515 - Serum Phosphorus Coding Guidelines
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| LCD Attachments back to top |
| There are no attachments for this LCD. |
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