The term heavy metal testing is historically used to describe elements such as
lead, arsenic, mercury, cadmium, and chromium. In general, all of the heavy
metals in inorganic form cause GI irritation, resulting in nausea, vomiting,
abdominal pain and diarrhea. The next most consistent toxicity for the heavy
metals as a group, but not for every heavy metal, is renal toxicity. A further
generalization is that each member of the heavy metal group tends to cause
multi-organ toxicity. Many metals cause cutaneous abnormalities, such as
irritant and allergic contact dermatitis, urticaria, keratoses, and
premalignant and malignant lesions. Several of the heavy metals produce
central and peripheral nervous system toxicity. Other metals cause pulmonary
illness.  
  

However, before any testing for heavy metal is ordered, a detailed medical
history of the patient must be obtained, including a careful documentation of
occupational and avocational exposure to these toxins. A complete physical
examination must be done. While classified as heavy metals, this policy does
not include iron or lithium since the former is typically tested for anemia
issues, discussed in National Coverage Determination 110.10 (Intravenous Iron
Therapy), and the latter is typically tested for monitoring of medications. In
addition, iron testing is covered under the National Coverage Determination
190.18 (Serum Iron Studies).  
  
  
1\. Aluminum. Serum aluminum testing is payable for beneficiaries who have
been on dialysis with evidence suggesting aluminum toxicity, or for
beneficiaries with chronic industrial exposure history  
  
2\. Antimony. Serum and/or urine antimony testing is payable for beneficiaries
with documented treatment in the past with antileishmaniasis agents or with
documented chronic antimony industrial exposure history.  
  
3\. Arsenic. Serum and whole blood and/or urine arsenic testing is payable for
beneficiaries with unexplained peripheral neuropathies, industrial exposure to
arsenic, histories of arsenic pesticide exposure, unexplained
encephalopathies, unexplained weight loss, chronic glomerulonephritis, bone
marrow hypoplasia, or melanosis of skin, unexplained chronic diarrhea,
persistent abdominal pain, or nausea and vomiting.  
  
4\. Barium. Serum and or/urine barium testing is payable for beneficiaries
with pulmonary disease with industrial exposure to barium or unexplained
flaccid paralysis.  
  
5\. Beryllium. Serum and/or urine beryllium testing is payable for
beneficiaries with pulmonary disease with industrial exposure to beryllium.  
  
6\. Bismuth. Serum and/or urine bismuth testing is payable for beneficiaries
with bismuth lines on their gums, methemoglobinemia, unexplained pathological
fractures, or a history of bismuth medicine abuse.  
  
7\. Cadmium. Serum and whole blood and/or urine cadmium testing is payable for
beneficiaries with an exposure to cadmium with evidence of pulmonary disease
or unexplained renal failure.  
  
8\. Chromium. Serum chromium testing is payable for beneficiaries with an
industrial exposure to chromium with evidence of pulmonary disease.  
  
9\. Cobalt. Serum cobalt testing is payable for beneficiaries with an
industrial exposure to cobalt with evidence of pulmonary disease  
  
10\. Copper. Serum copper testing is payable for beneficiaries with an
industrial exposure to copper with evidence of pulmonary disease, for
beneficiaries with Wilson's Disease, unexplained cardiomyopathy, unexplained
renal failure, polycythemia. unexplained myelodysplastic syndrome or known
ingestion of zinc.  
  
11\. Lead. Blood (serum and whole) and/or urine lead testing is covered if
there is documented industrial exposure to lead, documented avocation exposure
to lead, retained bullet fragments at or near joints, a blue gum line, a
history of moonshine abuse, unexplained peripheral neuropathies, evidence of
lead contaminated drinking water, paint stripping, lead lines on bones on
radiographs, or basophilic stippling of red blood cells.  
  
12\. Manganese. Serum manganese testing is covered for beneficiaries with
documented industrial exposure to manganese.  
  
13\. Mercury. Serum, whole blood, and/or urine mercury testing is covered for
beneficiaries with documented industrial exposure to mercury, with a blue line
in their mouth, those with a history of laxative abuse, with a history of
pesticide exposure, mercury spillage with vacuuming of the liquid metal,
unexplained renal failure, or a history of skin lightening treatments.  
  
14\. Molybdenum. Serum molybdenum testing is covered for beneficiaries with
documented industrial exposure to molybdenum.  
  
15\. Nickel. Serum and/or urine nickel testing is covered for beneficiaries
with documented industrial exposure to nickel, unexplained renal failure,
unexplained pulmonary disease.  
  
16\. Selenium. Serum and/or urine selenium testing is covered for
beneficiaries with documented industrial exposure to selenium or on chronic
renal dialysis.  
  
17\. Thallium. Serum thallium testing is covered for beneficiaries with
documented industrial exposure to thallium and unexplained ataxia.  
  
18\. Tin. Serum tin testing is covered for beneficiaries with documented
industrial exposure to tin.  
  
19\. Titanium. Serum titanium testing is covered for beneficiaries with
documented industrial exposure to titanium.  
  
20\. Zinc. Serum zinc and/or urine testing is covered for beneficiaries with
documented industrial exposure to zinc, on chronic renal dialysis, with
malabsorption syndromes, Crohn's disease, unexplained myelodysplastic syndrome
or known ingestion of zinc. Zinc testing is not covered for the assessment and
supplementation for the treatment of depression.  
  
21\. Testings for the following metals are non-covered: Boron, Phosphorous,
Silica, Strontium, Sulfur, Uranium, Vanadium  
  

Documented recent, long-term total parenteral nutrition (TPN) with clinical
trace element deficiency evidence is an acceptable medical indication for
testing for copper, manganese, and zinc.

  
  

Zinc deficiency is characterized by growth retardation, loss of appetite, and
impaired immune function as well as hair loss, diarrhea, impotence,
hypogonadism in males, eye and skin lesions, weight loss, delayed healing of
wounds, and taste abnormalities in more severe cases.1 Zinc nutritional status
is difficult to measure adequately using laboratory tests. Plasma or serum
zinc levels are the most commonly used indices for evaluating zinc deficiency,
but these levels do not necessarily reflect cellular zinc status.1 It has been
suggested that zinc and other micronutrients might influence depression.2 A
recent meta-analysis assessing the relationship between zinc deficiency and
depression concluded that there is insufficient evidence demonstrating a
causal effect. Furthermore, the authors noted that "the relationship between
serum zinc levels and depression could be partially explained by reverse
causation, whereby depression influences the intake, bioavailability or
biological regulation of zinc". Therefore, zinc assessment and supplementation
for the treatment of depression is considered not medically necessary.

Based on the evidence above, zinc assessment and supplementation for the
treatment of depression is considered not medically necessary.