Intracellular micronutrient testing (also known as: micronutrient testing, essential metabolic analysis, leukocyte nutrient analysis, functional micronutrient analysis) is a novel lab panel that measures the intracellular level of multiple nutrients. Micronutrients measured by this test include but are not limited to the following:
Intracellular micronutrient testing panel is considered experimental/investigational, and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.
| 82136 | 82180 | 82306 | 82310 | 82379 | 82495 | 82525 |
| 82607 | 82652 | 82725 | 82746 | 82978 | 83735 | 83785 |
| 84207 | 84252 | 84255 | 84425 | 84446 | 84590 | 84591 |
| 84597 | 84630 | 84999 | 86353 | 88348 |
Not Applicable
Not Applicable
Internal Medical Policy Committee 7-16-2019 New Policy
Internal Medical Policy Committee 5-19-2020 Annual Review
Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving and the Company reserves the right to review and update medical policy periodically.