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TSH denials from medicare

  1. Question TSH denials from medicare
    Medical Coding Books
    Hello! I work for a neurologist who regularly orders thyroid stim hormone assays (CPT 84443) in conjunction with other tests to check for Peripheral neuropathy after a trans ischemic attack or a stroke. The tests that come back abnormal are being paid, but we have 3 that came back normal that are being denied as not medically necessary. All 3 patients signed an ABN before having the test, but can't get the lab to tell me what diagnoses are covered for this test. My physician wants to know what she can do for her patients, because she always orders this test when she suspects neuropathy or MS. I can't find any NCD's except a generic one that says thyroid testing may be necessary for all sorts of issues and is covered up to 2x per year in stable patients. Would a letter of medical necessity help? What should be put in it? Is the patient still considered stable is a neuropathic condition is suspected? Does anyone know where I can find LCDs or NCDs, or a list of codes that area acceptable for this test?



  2. #2
    Sioux Falls South Dakota
    Hello! The NCD for Thyroid testing is 190.22. The list of covered diagnoses is too big to list here - it's very extensive. I would also look at the "Non-covered ICD9-CM codes for all NCD edits.

    Here is a link to the files:

    I hope this helps!
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. Default
    If the patient is on medication, v588.3 with v58.69 covers
    the TSH.

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