Thyroid testing reminder

In February 2022, updates to Clinical Utilization Management (UM) Guidelines were published with an August 1, 2022, effective date. These updates included changes to clinical coding edits for CG-LAB-20—Thyroid Testing. The updated guidelines state that only medically necessary lab testing for thyroid will be covered. Effective September 1, 2023, coverage for labs for [thyroid] will be denied unless medically necessary.

Clinical Indications for thyroid testing

Medically necessary

Thyroid function testing is considered medically necessary for individuals who meet any of the following indications:

• For evaluation of signs or symptoms consistent with thyroid disease
• To evaluate, assess, or monitor confirmed or suspected thyroid disease
• To evaluate thyroid function when there are risk factors for thyroid disease

Not medically necessary

The use of thyroid function testing is considered not medically necessary when the criteria listed above are not met, including as a screening test in the absence of risk factors.

Specific Clinical UM Guidelines are located at CG-LAB-20—ThyroidTesting.

What if I have questions?

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