Intracellular Micronutrient Analysis
*****Multiple individual codes could be used for each micronutrient utilized in these panels/tests*****
“Micronutrients” is a collective term used to describe essential vitamins and minerals. Clinical deficiency states (states occurring after prolonged consumption of a diet lacking the nutrient that is treated by adding the nutrient to the individual’s diet) have been reported for vitamins A, B1, B12, C and D, selenium, and other micronutrients. Classic nutritional deficiency diseases are uncommon in the United States as most individuals derive sufficient nutrition from diet alone or in combination with over-the-counter multivitamins.
Laboratory serum tests are available for individual micronutrients and are generally used to confirm suspected micronutrient deficiencies. This policy addresses laboratory tests that measure intracellular levels of micronutrients. This testing is also called micronutrient testing and functional intracellular analysis. Advocates claim that intracellular nutrient status is superior to serum testing because it reflects more stable micronutrient levels over longer time periods than serum levels; however, the relationship between serum and intracellular levels of micronutrients is complex. The balance of intra- and extracellular levels depend on a number of factors, including the physiology of cellular transport mechanisms and the individual cell type.
Proposed potential uses of this test include screening for nutritional deficiencies in healthy individuals or those with chronic disease and aiding in the diagnosis of disease in individuals with generalized symptoms. Examples of laboratories that perform intracellular micronutrient testing include SpectraCell, which offers a panel of tests that evaluates the intracellular status of micronutrients within lymphocytes in blood samples. The SpectraCell micronutrient panel also evaluates total antioxidant function. IntraCellular Diagnostics evaluates epithelial cells from buccal swabs and assesses levels of intracellular mineral electrolyte (i.e., magnesium, calcium, potassium, phosphorus, sodium, chloride).
Intracellular micronutrient analysis/panel testing is considered investigational.
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
No studies were identified that evaluate accuracy or clinical utility of intracellular micronutrient testing compared to serum testing for vitamin and mineral levels. There is limited data available in peer reviewed journals to evaluate the impact of this technology on health outcomes.
BlueCross BlueShield Association. Evidence Positioning System. (1:2019). Intracellular Micronutrient Analysis (2.04.73). Retrieved August 14, 2019 from https://www.evidencepositioningsystem.com/. (1 article reviewed)
CMS.gov: Centers for Medicare & Medicaid Services. Palmetto GBA. (2019, April). Local Coverage Determination. LCD: Assays for vitamins and metabolic function (L33418). Retrieved August 14, 2019 from www.cms.gov.
Houston, M. (2010). The role of cellular micronutrient analysis, nutraceuticals, vitamins, antioxidants and minerals in the prevention and treatment of hypertension and cardiovascular disease. Therapeutic Advances in Cardiac Disease, 4 (3) 165-183.
ORIGINAL EFFECTIVE DATE: 1/14/2012
MOST RECENT REVIEW DATE: 9/26/2019
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