Thyroid Nodule Molecular Testing
Policy Number: MP-128
Last Review Date: 02/21/2019
Effective Date: 01/01/2019
Policy
Evolent Health considers the following indications for molecular testing of thyroid
Fine-Needle Aspiration (FNA) samples are based on the Bethesda Reporting System of
Thyroid Cytology. Molecular testing of thyroid FNA samples is indicated for those
members who meet both of the following criteria:
1. Member has been diagnosed with a thyroid nodule
2. Cytological diagnosis of the thyroid FNA sample must be classified as
indeterminate under any one of the following categories:
a. AUS/FLUS
b. FN/SFN
c. SMC
Limitations
Molecular testing of thyroid FNA samples is not generally indicated and/or covered
when FNA cytology diagnosis is benign or malignant. Exceptions to this may be made
on a case by case basis by requesting prior authorization and documenting medical
necessity.
Background
The American Cancer Society estimates that for thyroid cancer in the United States for
2015 there will be about 62,450 new cases of thyroid cancer and 1,950 deaths from
thyroid cancer. A thyroid ultrasound is used to detect small thyroid nodules, discrete
masses present in the thyroid gland. Fine-needle aspiration (FNA) is used to evaluate
the nodules to exam for any benign lesions or malignant tumors.
The National Cancer Institute provides an overview on thyroid cancer and its four types:
papillary, follicular, medullary, and anaplastic thyroid cancer. Papillary thyroid cancer is
the most common type of thyroid cancer. Certain genetic conditions such as familial
medullary thyroid cancer, multiple endocrine neoplasia type 2A syndrome and multiple
endocrine neoplasia type 2B syndrome are identified risks known to increase the risk of
thyroid cancer.
Codes:
CPT Codes / HCPCS Codes / ICD-10 Codes
Code
Description
CPT Codes
81210
BRAF
