NCD 190.22

Item/Service Description

Thyroid function studies are used to delineate the presence or absence of hormonal abnormalities of the thyroid and pituitary glands. These abnormalities may be either primary or secondary and often but not always accompany clinically defined signs and symptoms indicative of thyroid dysfunction.

Laboratory evaluation of 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. Measurements of serum sensitive thyroid-stimulating hormone (TSH) levels, complemented by determination of thyroid hormone levels [free thyroxine (fT-4) or total thyroxine (T4) with Triiodothyronine (T3) uptake] are used for diagnosis and follow-up of patients with thyroid disorders.

Additional tests may be necessary to evaluate certain complex diagnostic problems or on hospitalized patients, where many circumstances can skew tests results. When a test for total thyroxine (total T4 or T4 radioimmunoassay) or T3 uptake is performed, calculation of the free thyroxine index (FTI) is useful to correct for abnormal results for either total T4 or T3 uptake due to protein binding effects.

Indications and Limitations of Coverage

Indications

Thyroid function tests are used to define hyper function, euthyroidism, or hypofunction of thyroid disease. Thyroid testing may be reasonable and necessary to:

• Distinguish between primary and secondary hypothyroidism;

• Confirm or rule out primary hypothyroidism;

• Monitor thyroid hormone levels (for example, patients with goiter, thyroid nodules, or thyroid cancer);

• Monitor drug therapy in patients with primary hypothyroidism;

• Confirm or rule out primary hyperthyroidism; and

• Monitor therapy in patients with hyperthyroidism.

Thyroid function testing may be medically necessary in patients with disease or neoplasm of the thyroid and other endocrine glands. Thyroid function testing may also be medically necessary in patients with metabolic disorders; malnutrition; hyperlipidemia; certain types of anemia; psychosis and non-psychotic personality disorders; unexplained depression; ophthalmologic disorders; various cardiac arrhythmias; disorders of menstruation; skin conditions; myalgias; and a wide array of signs and symptoms, including alterations in consciousness; malaise; hypothermia; symptoms of the nervous and musculoskeletal system; skin and integumentary system; nutrition and metabolism; cardiovascular; and gastrointestinal system.

It may be medically necessary to do follow-up thyroid testing in patients with a personal history of malignant neoplasm of the endocrine system and in patients on long-term thyroid drug therapy.

Limitations

Testing may be covered up to two times a year in clinically stable patients; more frequent testing may be reasonable and necessary for patients whose thyroid therapy has been altered or in whom symptoms or signs of hyperthyroidism or hypothyroidism are noted.

Note: Scroll down for links to the quarterly Covered Code Lists (including narrative).

Cross Reference

Also see the Medicare Claims Processing Manual, Chapter 120, Clinical Laboratory Services Based on Negotiated Rulemaking.

Other

Covered Code Lists (including narrative)

January 2026 (PDF) (ICD-10)

October 2025 (PDF) (ICD-10)

January 2025 (PDF) (ICD-10)

October 2024 (PDF) (ICD-10)

July 2024 (PDF) (ICD-10)

April 2024 (PDF) (ICD-10)

January 2024 (PDF) (ICD-10)

October 2023 (PDF) (ICD-10)

July 2023 (PDF) (ICD-10)

April 2023 (PDF) (ICD-10)

January 2023 (PDF) (ICD-10)

October 2022 (PDF) (ICD-10)

July 2022 (PDF) (ICD-10)

April 2022 (PDF) (ICD-10)

January 2022 (PDF) (ICD-10)

October 2021 (PDF) (ICD-10)

July 2021 (PDF) (ICD-10)

April 2021 (PDF) (ICD-10)

January 2021 (PDF) (ICD-10)

October 2020 (PDF) (ICD-10)

July 2020 (PDF) (ICD-10)

April 2020 (PDF) (ICD-10)

January 2020 (PDF) (ICD-10)

October 2019 (PDF) (ICD-10)

July 2019 (PDF) (ICD-10)

April 2019 (PDF) (ICD-10)

January 2019 (PDF) (ICD-10)

October 2018 (PDF) (ICD-10)

July 2018 (PDF) (ICD-10)

April 2018 (PDF) (ICD-10)

January 2018 (ICD-10)

October 2017 (ICD-10)

July 2017 (ICD-10)

April 2017 (ICD-10)

January 2017 (ICD-10)

October 2016 (ICD-10)

January 2016 (ICD-10)

October 2015 (ICD-10, ICD-9)

October 2014 (ICD-10, ICD-9)

Changes to Lab NCD Edit Software

January 2026

October 2025

January 2025

October 2024

July 2024

January 2024

October 2023

April 2023

January 2023

October 2022

April 2022

January 2022

October 2021

July 2021

October 2020

April 2020

January 2020

October 2019

July 2019

January 2019

October 2018

April 2018

January 2018

July 2017

April 2017

January 2017

January 2016

October 2014

Revision History

07/2004 - Published NCD in the NCD Manual without change to narrative contained in PM AB-02-110. Coding guidance now published in Medicare Lab NCD Manual. Effective and Implementation dates NA. (TN 17) (CR 2130)

07/2002 - Implemented NCD. Effective date 11/25/02. Implementation date 1/01/03. (TN AB-02-110) (CR 2130)