Aetna considers chemical hair analysis experimental and investigational, except for diagnosis of suspected chronic arsenic poisoning.
Note: Microscopic evaluation of hair structure (trichogram) may be medically necessary as part of the work-up of members with alopecia or abnormal-appearing or abnormally growing hair.
Note: Although hair samples may be used for verifying abuse of illicit substances in persons who wish to evade detection, its use in this situation is not considered treatment of disease.
Background
Hair analysis has been proposed as an aid in the diagnosis of disorders such as mineral or protein deficiency or mineral toxicity. Hair analysis has not been proven to be effective in ascertaining mineral or metabolic imbalances or IgE-mediated allergic diseases. Hair analysis has also not been proven to be of use in either the diagnosis or treatment of autism.
Because arsenic is taken up and bound in hair and fingernails, analysis of hair and nails have been used to detect chronic arsenic exposure (Goldman, 2008). However, in a setting in which air exposure is a consideration, as in an industrial environment, it is very difficult to remove exogenous arsenic from hair, and therefore to get a reliable reading. Also a lack of standardization of analysis contributes to the variability of results from hair and nail testing. Goldman (2008) explained that commercial laboratory hair analyses for multiple elements including arsenic are highly inaccurate. Determination of arsenic in hair and nails has been most useful in epidemiological studies performed to evaluate environmental exposures of populations to inorganic arsenic; it is less useful in the evaluation of an individual patient (Goldman, 2008).
Microscopic evaluation of hair structure (trichogram) may be indicated as part of the work-up of members with alopecia or abnormal-appearing or abnormally growing hair. Hair may be examined under the microscope to determine the number of hairs that are actively growing (anagen phase) versus the resting phase (telogen). In addition, microscopic examination of clipped hair can reveal structural abnormalities of the hair bulb or shaft.
CPT Codes / HCPCS Codes / ICD-9 Codes
Chemical hair analysis:
CPT codes covered if selection criteria are met:
82175
83015
HCPCS codes not covered for indications listed in the CPB:
P2031
Hair analysis (excluding arsenic)
ICD-9 codes covered if selection criteria are met:
961.1
Poisoning by arsenical anti-infectives
985.1
Toxic effect of arsenic and its compounds
E866.3
Accidental poisoning by arsenic and its compounds and fumes
V82.5
Special screening for chemical poisoning and other contamination
ICD-9 codes not covered for indications listed in the CPB (not all-inclusive):
269.3
Mineral deficiency, not elsewhere classified
270.0 - 277.9
Other metabolic disorders
281.4
Protein-deficiency anemia
299.00, 299.01
Autistic disorder
477.0 - 477.9
Allergic rhinitis
493.00 - 493.92
Asthma
691.8
Other atopic dermatitis and related conditions
693.1
Dermatitis due to food taken internally
708.0 - 708.9
Urticaria
796.0
Nonspecific abnormal toxicological findings
989.5
Toxic effect of venom
995.0
Other anaphylactic shock
995.1
Angioneurotic edema
995.20 - 995.29
Other and unspecified adverse effect of drug, medicinal and biological substance
995.3
Allergy, unspecified
995.60 - 995.69
Anaphylactic shock due to adverse food reaction
995.7
Other adverse food reactions, not elsewhere classified
V15.0 - V15.09
Allergy, other than medicinal agents
V77.99
Special screening for other and unspecified endocrine, nutritional, metabolic, and immunity disorders
Microscopic evaluation of hair structure (trichogram):
CPT codes covered if selection criteria are met:
96902
ICD-9 codes covered if selection criteria are met:
704.00 - 704.09
Alopecia
704.2
Abnormalities of hair
704.8 - 704.9
Other and unspecified diseases of hair and hair follicles
The above policy is based on the following references:
U.S. Department of Health and Human Services, Health Care Financing Administration (HCFA). Hair analysis -- not covered. Medicare Coverage Issues Manual §50-24. Baltimore, MD: HCFA; 2000.
Lazar P. Hair analysis: What does it tell us? JAMA. 1974;229:1908-1909.
Hambidge KM. Hair analyses: Worthless for vitamins, limited for minerals. Am J Clin Nutr. 1983;36:943-949.
Klevay LM, Bistrian BR, Fleming CR, Neumann CG. Hair analysis in clinical and experimental medicine. Am J Clin Nutr. 1987;46(2):233-236.
Barrett S. Commercial hair analysis: Science or scam? JAMA. 1985;254:1041-1045.
Filipek PA, Accardo PJ, Ashwal S, et al. Practice parameter: Screening and diagnosis of autism. Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology. 2000;55(4):468-479.
Kruse-Jarres JD. Limited usefulness of essential trace element analyses in hair. Am Clin Lab. 2000;19(5):8-10.
Hu H. Exposure to metals. Prim Care. 2000;27(4):983-996.
Hindmarsh JT. Caveats in hair analysis in chronic arsenic poisoning. Clin Biochem. 2002;35(1):1-11.
Niggemann B, Gruber C. Unproven diagnostic procedures in IgE-mediated allergic diseases. Allergy. 2004;59(8):806-808.
Tsatsakis A, Tutudaki M. Progress in pesticide and POPs hair analysis for the assessment of exposure. Forensic Sci Int. 2004;145(2-3):195-199.
Dolan K, Rouen D, Kimber J. An overview of the use of urine, hair, sweat and saliva to detect drug use. Drug Alcohol Rev. 2004;23(2):213-217.
Passalacqua G, Compalati E, Schiappoli M, Senna G. Complementary and alternative medicine for the treatment and diagnosis of asthma and allergic diseases. Monaldi Arch Chest Dis. 2005;63(1):47-54.
Savvopoulos MA, Pallis E, Tzatzarakis MN, et al. Legal issues of addiction assessment: The experience with hair testing in Greece. J Appl Toxicol. 2005;25(2):143-152.
Gambelunghe C, Rossi R, Ferranti C, et al. Hair analysis by GC/MS/MS to verify abuse of drugs. J Appl Toxicol. 2005;25(3):205-211.
Kapaj S, Peterson H, Liber K, Bhattacharya P. Human health effects from chronic arsenic poisoning--a review. J Environ Sci Health A Tox Hazard Subst Environ Eng. 2006;41(10):2399-2428.
Caprara DL, Klein J, Koren G. Diagnosis of fetal alcohol spectrum disorder (FASD): Fatty acid ethyl esters and neonatal hair analysis. Ann Ist Super Sanita. 2006;42(1):39-45.
Ng DK, Chan CH, Soo MT, Lee RS. Low-level chronic mercury exposure in children and adolescents: Meta-analysis. Pediatr Int. 2007;49(1):80-87.
Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
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