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Anthem Blue Cross ConnecticutCommercial Clinical Policy

Anthem Blue Cross Connecticut CG-LAB-29 Gamma Glutamyl Transferase Testing Form


Gamma Glutamyl Transferase (GGT) Testing

Indications

(596850) Is the GGT testing used to differentiate between sources of elevated alkaline phosphatase activity? 
(596851) Is the patient being evaluated for liver function, injury or disease? 
(596852) Does the patient have known or suspected hepatobiliary disease? 
(596853) Does the patient have an alcohol use disorder? 
(596854) Does the patient have a substance use disorder? 

YesNoN/A
YesNoN/A
YesNoN/A

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Effective Date

09/27/2023

Last Reviewed

05/11/2023

Original Document

  Reference



This document addresses laboratory testing of gamma glutamyl transferase (GGT) in blood.

Clinical Indications

Medically Necessary:

GGT testing using blood is considered medically necessary for any of the following indications:

  1. To differentiate between sources of elevated alkaline phosphatase activity; or
  2. To evaluate liver function, injury or disease in individuals with at least one of the following:
    1. Known or suspected hepatobiliary disease; or
    2. Alcohol use disorder; or
    3. Substance use disorder; or
    4. Therapy with medication that has potentially toxic effects on the liver; or
    5. Exposure to hepatotoxins; or
    6. Infections that may cause liver injury (for example, viral hepatitis, amoebiasis, tuberculosis, and similar infections); or
    7. Pancreatic disease; or
    8. Gastrointestinal disease; or
    9. Liver transplantation; or
    10. Primary or secondary malignant neoplasms; or
    11. Diseases or conditions known to have liver involvement (for example, diabetes mellitus, sarcoidosis, amyloidosis, disorders of iron and mineral metabolism, lupus, hypertension, heart failure).

Not Medically Necessary:

GGT testing using blood is considered not medically necessary when the above criteria are not met.