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Medical Policy: 02.04.10
Original Effective Date: August 2006
Reviewed: September 2011
Revised:
Benefit Application
Benefit determinations are based on the applicable contract language in effect at the time the
services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary
based on contract, and individual member benefits must be verified. Wellmark determines medical
necessity only if the benefit exists and no contract exclusions are applicable. This medical
policy may not apply to FEP. Benefits are determined by the Federal Employee Program.
This Medical Policy document describes the status of medical technology at the time the document
was developed. Since that time, new technology may have emerged or new medical literature may
have been published. This Medical Policy will be reviewed regularly and be updated as scientific
and medical literature becomes available.
Description:
Intracellular magnesium measurement is performed by x-ray dispersive microanalysis using a specially configured electron microscope which images cells with a focused electron beam. Sublingual epithelial cells are particularly amenable to this method of measurement because they are easily accessible, non-cornified, aerobic, turnover in less than three days, have a high cytoplasm to nucleus ratio, exhibit 99% viability, and show significant correlations with cardiac and muscle tissue.
Magnesium plays a protean role in intracellular metabolism, and is the second most common intracellular cation in human physiology. Cellular magnesium activates a number of enzyme systems affecting normal functions as well as pathological syndromes. It is theorized then, that measuring magnesium within tissues contributes to the understanding and treatment of many diseases, including atherosclerosis, arrhythmias, myocardial infarction. hypertension, sudden cardiac death, and chronic fatigue syndrome. There is insufficient evidence to permit conclusions regarding the clinical utility of measurements of intracellular magnesium.
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Prior Approval:
Not applicable
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Policy:
Measurement of intracellular magnesium is considered not medically necessary.
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Procedure Codes and Billing Guidelines:
- To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9-CM diagnostic codes.
- 88199 Unlisted cytopathology procedure
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Selected References:
- Shechter M, Sharir M, Labrador MJP et al. Oral Magnesium Therapy Improves Endothelial Function in Patients With Coronary Artery Disease. Circulation. 2000; 102:2353-5358.
- Piotrowski AA, Kalus JS. Magnesium for the Treatment and Prevention of Atrial Tachyarrythmias. Pharmacotherapy 24(7): 879-895. 2004.
- Shechter M, Merz CNB, Stuehlinger H-G et al. Effects of Oral Magnesium Therapy on Exercise Tolerance, Exercise-Induced Chest Pain, and Quality of Life in Patients With Coronary Artery Disease. Am J Cardiol 2003; 91:517-521.
- Haigney M, Silver, B, Tanglao E et al. Noninvasive Measurement of Tissue Magnesium and Correlation With Cardiac Levels. Circulation. 1995; 92:2190-2197.
- Johnson S. The Multifaceted and Widespread Pathology of Magnesium Deficiency. Medical Hypotheses (2001) 56(2): 163-170.
- Weissberg N, Schwartz G, Shemesh O et al. Serum and Intracellular Electrolytes in Patients With and Without Pain. Magnesium Research (1991); 4(1): 49-52.
- McClean RM. Magnesium and Its Therapeutic Uses: A Review. Am J Med. 1994. 96:63-76.
- Elin RJ. Magnesium: The Fifth But Forgotten Electrolyte. Am J Clin Pathol 1994; 102:616-622.
- Silver, B. Development of Cellular Magnesium Nano-Analysis in Treatment of Clinical Magnesium Deficiency. Journal of the American College of Nutrition. 23(6): 732S-737S (2004 ).
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Policy History:
Date Reason Action
September 2011 Annual review Policy renewed
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Wellmark medical policies address the complex issue
of technology assessment of new and emerging treatments, devices,
drugs, etc. They are developed to
assist in administering plan benefits and constitute neither offers of
coverage nor medical advice. Wellmark medical policies contain only a
partial, general description of plan or program benefits and do not
constitute a contract. Wellmark 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 Wellmark or its
affiliates. Treating providers are solely responsible for medical
advice and treatment of members. Our medical policies may be updated
and therefore are subject to change without notice.
*Current Procedural Terminology © 2010 American Medical Association. All Rights Reserved.
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