Laboratory test to measure homocysteine levels in the blood
CPT® code 83090 is used to report a quantitative laboratory test measuring homocysteine levels in a patient’s blood. This test evaluates the concentration of homocysteine, an amino acid involved in methionine metabolism. Elevated homocysteine levels can indicate increased risk for cardiovascular disease, vitamin B12 or folate deficiency, or certain metabolic disorders.
When to Use CPT® Code 83090
Use 83090 when a provider orders a homocysteine test to:
- Assess risk of cardiovascular or thrombotic disease
- Evaluate vitamin B12, B6, or folate deficiency
- Monitor patients with known metabolic or genetic conditions affecting homocysteine metabolism
- Investigate unexplained neurological symptoms, fatigue, or vascular inflammation
- Support ongoing management of patients with nutritional deficiencies or methylation-related disorders
This test can be performed on serum or plasma and is typically ordered as part of a comprehensive diagnostic workup.
Documentation Requirements
To ensure proper billing for 83090, documentation should include:
- The clinical indication for ordering the test (e.g., suspected B12 deficiency, cardiovascular risk evaluation)
- The type of specimen collected (typically venous blood)
- The method of analysis used by the laboratory
- Any related laboratory results or differential diagnostic considerations
- Provider’s interpretation and follow-up plan based on the results
Accurate documentation supports medical necessity and facilitates payer reimbursement.
Billing Guidelines
- Report 83090 once per patient encounter when homocysteine is measured in serum or plasma.
- This code should not be reported with other tests unless a separate and distinct analysis is performed.
- If multiple assays or profiles are performed, follow payer-specific bundling rules.
- Results should be correlated with other lab findings and clinical evaluation for accurate interpretation.
Example
A provider orders a homocysteine blood test for a patient presenting with fatigue, numbness, and elevated mean corpuscular volume (MCV) on CBC results. The test reveals an increased homocysteine level, helping confirm a vitamin B12 deficiency. The service is appropriately billed using CPT® 83090.
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