Lactose Tolerance Test CPT Codes | CPT 82951 & CPT 82952 | Billing Guide

CPT 82951 and CPT 82952 can be billed for chemistry-related medical treatments like a Lactose tolerance test. Lactose tolerance test CPT codes describe how quickly glucose leaves the bloodstream after being loaded with the drug under specified and controlled conditions. 

Lactose measurements can be diagnosed and treat disorders with carbohydrate metabolisms, such as diabetes mellitus, idiopathic hypoglycemia, and gestational diabetes. 

A laboratory analyst will take three blood glucose readings from the patient: one while the patient is fasting, one before, and two hours after receiving an oral glucose dose. The code for laboratory chemistry and pathology in medical billing is CPT code 82952. 

CPT code 82952 can be used as a lactose tolerance test CPT code. On the treatment date, Medicare will only pay for lactose laboratory testing services if the ordering provider and the DME provider are active Medicare members. For information on becoming a Medicare-approved ordering or referring physician, see “Medicare Enrollment Guidelines for Providers.”

Individuals receiving Medicare have pre-diabetic symptoms, digestion problems, or risk factors for developing diabetes. This benefit is not available to Medicare participants who have previously been diagnosed with diabetes and go through the lactose tolerance test.

Some important points should keep in mind that are listed below.

• Pre-diabetic Medicare beneficiaries will screen for lactose testing twice a year.
• If you have never been evaluated for lactose tolerance measurement but have previously been, you should screen once a year.
• Individual Payment for Medicare Services
• Exemptions from copayments and coinsurance

The Clinical Diagnostic Laboratory Services NCD Edit Module will apply for glucose tolerance tests. Bill CPT code 82947 with diagnosis code V77.1 for the test.

Only the first claim for the same laboratory service for lactose tolerance test submitted by the same group physician or healthcare practitioner will pay. Duplicate Laboratory Services (CPT 82947 and CPT 82948) are not included.

Report modifier 91 for the same physician or another healthcare professional who performs two independent surgeries on the same day will classify as two distinct patients.

Only one laboratory supplier can be compensated when multiple people report Duplicate Laboratory Services.

Many other professionals, such as physicians, nurses, and pathologists who can be detected duplicate services, reference laboratories, referring laboratories, and other laboratories, fall under the category of “health care providers.” “Duplicate Laboratory Services” CPT codes 82947 and 82948 do not apply. Glucose Tolerance Test (GTT) Specimens (x3): 82951 (includes glucose).

Patients who are pre-diabetic and have had a screening test must have the TS modifier added to their claim (follow-up service).

Diabetes testing under Medicare requires an ICD 10 CM V77.1 diagnosis code (special screening for endocrine, nutritional, metabolic, and immunological diseases, diabetes mellitus).

82952 & 82951 CPT Code Description

CPT code 82951 can be reported for a lactose tolerance test with a maximum of three specimens. Add-on CPT code 82952 can be used to bill each additional specimen beyond the first three.

Below you can find the official descriptions of the CPT codes for the lactose tolerance test.

CPT 82951: CPT code 82951 can be used for three specimens of a lactose tolerance test and is officially described in CPT’s manual as: “Glucose; tolerance test (GTT), three specimens (includes glucose).”

CPT 82952: Add-on CPT code 82952 can be used for each additional specimen of a lactose tolerance test and is officially described in CPT’s manual as: “Glucose; tolerance test, each additional beyond three specimens (List separately in addition to code for primary procedure).”

Lactose tolerance tests can be classified into two categories. In both cases, the subject is given a beverage with a known amount of lactose. Before and after the lactose beverage ingests, a series of timed samples will also collect.

Patients should be allowed to burn calories and consume at least 150 grams of carbs per day for three days before a diagnostic glucose tolerance test.

They instruct patients to drink just water for eight to fourteen hours before the test is critical. Furthermore, patients should advise stopping using any drugs that may influence glucose metabolism at least three days before testing.

When submitting lactose intolerance test CPT codes to Medicare, those with prediabetes can also add CPT 82947, CPT 82950, and CPT 82951 in conjunction with the diagnosis code V77.1O.

The CWF stipulates that CPT 82947 and CPT 82951, connected with diagnosis code ICD 10 CM V77.10, can be billed only once every six months.

Contractors should reject claims for 82947 and 82951 when they get a CWF to leave, indicating that the dates of service are more frequent than two screening tests per year for those with prediabetes.

Nothing but water is allowed; an overnight fast is required before the lactose intolerance test. Two weeks before the test, it would be best to stop using antibiotics and gastrointestinal drugs, such as laxatives, antacids, and stool softeners.

Any additional medications patients are taking should be disclosed to the healthcare provider. Steer clear of demanding activities. 

Billing Guidelines For The Lactose Tolerance Test CPT Codes

Glucose is included as a specimen for both lactose tolerance test CPT codes 82951 and 82952. Use CPT 82951 to report the first three specimens. Add-on CPT code 82952 can be reported for each additional specimen. It is not allowed to bill CPT 82952 without CPT code 82951.

Report CPT 80434 and CPT 80435 for insulin tolerance test. The leucine tolerance test can be billed with CPT 80428. Report CPT 81000, CPT 81002, CPT 81005, and CPT  81099 for semiquantitative urine glucose.

The patients undergoing a lactose tolerance CPT code procedure are entitled to two free annual screenings. Lactose screening tests can be covered by Medicare as long as the lab bills adhere to the Medicare Clinical Laboratory Fee Schedule. 

The screening diagnosis code V77.1 should be placed into the header diagnosis section of the claim to indicate that the test(s) performs as part of a diabetes screening.

The screening diagnosis code V77.1 and modifier “TS” – follow-up service must include in the claim’s header diagnostic section to indicate that the test(s) could perform to detect diabetes in a pre-diabetic. 

MSN 18.4 is necessary for all contractors. Patient file a claim for a diabetic screening with the diagnosis code V77.1 and receives a CWF reject for CPT 82947, CPT 82950, or CPT 82951. No patient copayment should be required for Medicare-covered laboratory tests listed on the Medicare Laboratory Fee Schedule.

Contractors can reject claims for CPT 82947, CPT 82950, and CPT 82951 billed with diagnosis code V77.1 and modifier “TS” if they receive a CWF reject stating that the service dates are more than once per six months.

Contractors can be used the relevant claims adjustment reason code, such as 119, “Benefit maximum for this period or occurrence will achieve.

Contractors must apply MSN 18.4 when rejecting claims based on CWF refusal for CPT 82947, CPT 82950, and CPT 82951. “The service claim will reject if it has been less than six months since your last inspection of this type.”

The Medicare Laboratory Fee Schedule contains all of these test codes and more. A lactose tolerance test will cost Medicare $5.48. 

How To Use Modifiers With CPT Codes For Lactose Tolerance Test

Modifier 91 indicates when lactose tolerance test CPT codes are conducted on the same patient on the same day to collect fresh test results throughout treatment. This term suggests “Repeat clinical diagnostic laboratory test,” according to CPT guidelines.

It’s simple to see why it’s critical to include the appropriate modifiers when invoicing the same CPT for a lactose tolerance test many times on the same day for the same patient for conducting the same laboratory test, like a lactose screening test.

Understandably, the 91 modifiers can be confused with the modifier 59, which can be used for a distinct type of laboratory testing like lactose and diabetic testing. While modifier 59 can be used for various scenarios, modifier 91 should be restricted to laboratory services and provides. 

In most circumstances, modifier 91 should be used instead of modifier 59 for billing purposes in the laboratory. Use ICD ICD-10 CM Z13.1 to demonstrate that you have undergone a diabetes screening (Encounter for screening for diabetes mellitus). 

If a Medicare beneficiary meets the criteria for prediabetes, the relevant diagnostic code and modifier TS should enter when submitting a claim for diabetes screening. Contractors primarily use the TS modifiers for billing lactose tolerance test CPT codes.

Reimbursement

Medicare will reimburse CPT 82951 and/or CPT 82952 for two Lactose tolerance tests per year for pre-diabetic people, as long as both screenings perform in the same calendar year (but no less than six months apart). Medicare recipients are eligible for one free diabetes screening test per year.

Additionally, medical professionals should rule out irritable bowel syndrome, celiac disease, and other inflammatory bowel illnesses before administering a lactose tolerance test.

The physical examination will likely include searching for stomach discomfort or fullness indicators. Because lactose intolerance is prevalent in families, individuals may wish to determine whether they are at risk.

For the reimbursement process, modifier 91 can be with the CPT codes for lactose intolerance test.

Example

A patient of 49 years old has a digestion problem with diabetic symptoms. The doctor will advise the patient to abstain from milk and milk products for a few days for lactose intolerance testing.

Report the CPT codes for lactose tolerance testing in this case.