Unit Code CPT Code 38103 82306 Vitamin D, 25 Hydroxy 36138 82652 Vitamin D, 1,25 Hydroxy
Vitamin D ICD 10 Codes that Meet Medical Necessity Proprietary Information of Cigna Companies Copyright 2018, Cigna Proprietary Information of Cigna Companies Unit Code CPT Code 38103 82306 Vitamin D, 25 Hydroxy 36138 82652 Vitamin D, 1,25 Hydroxy
Proprietary Information of Cigna Companies Unit Code CPT Code 38103 82306 Vitamin D, 25 Hydroxy 36138 82652 Vitamin D, 1,25 Hydroxy
Normal levels of Vitamin D range from 20 – 50 ng/dl. This LCD identifies the indications and limitations of Medicare coverage and reimbursement for the lab assay. Indications: Measurement of 25-OH Vitamin D, CPT 82306, level is indicated for patients with:
This test is appropriate for assessment of vitamin D deficiency. Vitamin D, 1,25-dihydroxy (CPT code 82652) is primarily indicated during patient evaluations for hypercalcemia and renal failure.
For 82306: If more than one LCD-listed condition contributes to Vitamin D deficiency in a given patient and/or is improved by Vitamin D administration, coders should use: ICD-10 E55. 9 UNSPECIFIED VITAMIN D DEFICIENCY. This code should not be used for any other indication.
Group 1CodeDescription82306VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED82652VITAMIN D; 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED
25 hydroxy vitamin D2 (ergocalciferol) is the vitamin D that you have absorbed from foods fortified with plant vitamin D or from an ergocalciferol supplement. The two hormones (ergo- and cholecalciferol) work similarly in the body. The important value is the total 25 hydroxy vitamin D level in your blood.
ICD-10 code: E55. 9 Vitamin D deficiency, unspecified.
Vitamin D testing is unproven and not medically necessary for routine preventive screening due to insufficient evidence of efficacy. Vitamin D testing is proven and medically necessary for conditions or medical diagnoses associated with Vitamin D deficiency or risk of hypercalcemia.
For Medicare beneficiaries, screening tests are governed by statute. Vitamin D testing may not be used for routine screening. Once a beneficiary has been shown to be vitamin D deficient, further testing is medically necessary only to ensure adequate replacement has been accomplished.
Medicare considers vitamin assay panels (more than one vitamin assay) a screening procedure and therefore, non-covered.
Cyanocobalamin (Vitamin B-12) CPT-4 code 82607 (cyanocobalamin [vitamin B-12]) is reimbursable only when billed in conjunction with one or more of the following ICD-10-CM codes. Reimbursement is restricted to three (3) tests per year for the same recipient by the same provider, unless medical justification is provided.
The reference range of the total 25(OH)D level is 25-80 ng/mL.
Tests for Vitamin D Deficiency The most accurate way to measure how much vitamin D is in your body is the 25-hydroxy vitamin D blood test. A level of 20 nanograms/milliliter to 50 ng/mL is considered adequate for healthy people.
Low blood levels of 25-hydroxy vitamin D usually mean one (or more) of the following: you aren't eating a balanced, complete diet. your intestines aren't absorbing the vitamin properly. you're not spending enough time outside to absorb adequate vitamin D levels through sun exposure.
For Medicare beneficiaries, screening tests are governed by statute. Vitamin D testing may not be used for routine screening. Once a beneficiary has been shown to be vitamin D deficient, further testing is medically necessary only to ensure adequate replacement has been accomplished.
Cyanocobalamin (Vitamin B-12) CPT-4 code 82607 (cyanocobalamin [vitamin B-12]) is reimbursable only when billed in conjunction with one or more of the following ICD-10-CM codes. Reimbursement is restricted to three (3) tests per year for the same recipient by the same provider, unless medical justification is provided.
Medicare will not cover more than one test per year, per beneficiary except as noted below. Certain tests may exceed the stated frequencies, when accompanied by a diagnosis fitting the exception description for exceeding the once per annum maximum.
Do Medicare prescription drug plans cover vitamin D3? No. In general, Medicare prescription drug plans (Part D) do not cover this drug.
Vitamin D, 25-Hydroxy, Total, Immunoassay - Measurement of serum 25-OH vitamin D concentrations provide a good index of circulating vitamin D activity in patients not suffering from renal disease. Lower than normal 25-OH vitamin D levels can result from a dietary deficiency, poor absorption of the vitamin or impaired metabolism of the sterol in the liver.
Learn about 25-hydroxy vitamin D test, find a doctor, complications, outcomes, recovery and follow-up care for 25-hydroxy vitamin D test.
In some jurisdictions (eg, Florida, Pennsylvania, the Southwest region), Medicare coverage includes testing up to 3 times per year. In most jurisdictions, Medicare has expanded coverage for vitamin D testing for at-risk patients who have a BMI ≥30.
Labcorp test details for 25-Hydroxy Vitamin D (D2+D3 Fractionated), LC/MS-MS. The biological function of vitamin D is to maintain normal levels of calcium and phosphorus absorption. 25-Hydroxy vitamin D is the storage form of vitamin D. Vitamin D assists in maintaining bone health by facilitating calcium absorption.
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Vitamin D; 25 hydroxy, includes fraction (s), if performed.
History/Background and/or General Information Vitamin D, a group of fat-soluble prohormones, is an essential Vitamin. There are two major types of Vitamin D (Vitamin D2 and Vitamin D3) which are collectively known as calciferol.
Often, one type is more appropriate for a certain disease state than another. The most common type of vitamin D deficiency is 25-OH vitamin D . A much smaller percentage of 1,25 dihydroxy vitamin D deficiency exists; mostly, in those with renal disease.
Currently, the best accepted measure for assessing vitamin D status is total serum 25 (OH)D, expressed in ng/mL or nmol/L . The Institute of Medicine lists the following vitamin D value cutoffs:
Vitamin D is called a "vitamin" because of its exogenous source, predominately from oily fish in the form of vitamin D 2 and vitamin D 3. It is more accurate to consider fat-soluble Vitamin D as a steroid hormone, synthesized by the skin and metabolized by the kidney to an active hormone, calcitriol.
Screening for Vitamin D deficiency (i.e., testing to determine if someone without signs or symptoms is vitamin D deficient) is not medically necessary in healthy adults as there is limited clinical evidence to support routine screening in this population.
Various component sources of 25-OH vitamin D, such as stored D or diet-derived D, should not be billed separately. Once a beneficiary has been shown to be vitamin D deficient, further testing may be medically necessary only to ensure adequate replacement has been accomplished.
Harvard Pilgrim Health Care considers vitamin D screening and testing as not medically necessary for all other indications. In addition, HPHC does not cover:
The majority of 25-OH vitamin D (25-D) in the circulation is derived from the conversion of 7-dehydrocholesterol in the skin that is irradiated with ultraviolet radiation in the UVB range (wavelength 290 nm to 315 nm). 1-5 The extent of vitamin D formation is not tightly controlled and depends primarily on the duration and intensity of the UV irradiation. Levels produced typically reach a plateau within 30 minutes of exposure. Unfortunately, use of a sunscreen with SPF as low as 15 reduces the rate of vitamin D production by 99.9%. Overproduction of vitamin D in the skin is prevented by the photosensitive conversion of vitamin D to tachysterol or lumisterol. Vitamin D is not very water-soluble, so it must be delivered to and carried in the blood as a complex with vitamin D-binding protein. Once in the circulation, vitamin D is metabolized to 25-hydroxy vitamin D (25-D) by the liver. The 25-D form of the hormone is the principle circulating reservoir in plasma and is generally the best indicator of overall vitamin D status. 25-D is further metabolized by the kidney to produce the biologically active form of vitamin D, 1,25-dihydroxy vitamin D (1,25-D). Renal production of 1,25-D is tightly controlled by parathyroid hormone and is important in the regulation of serum calcium homeostasis.
Many tissues and cells in the body have vitamin D receptors. 1-3 It has been estimated that the expression of as much as one third of the human genome is influenced by 1,25- (OH)2 vitamin D. Many studies have demonstrated an association of vitamin D deficiency with increased risk for:
The World Health Organization's International Agency for Research on Cancer (IARC) has concluded that there is a strong link between an individual's vitamin D levels and the risk of developing colorectal cancer. 5 Studies have also revealed that low vitamin D levels are associated with an increased incidence of other malignancies, including breast cancer. 8
Vitamin D plays an integral role in calcium homeostasis and the maintenance of healthy bone. Vitamin D stimulates the absorption of calcium at the level of the intestine and may also serve to increase calcium and phosphate resorption at the kidney level. Deficiency of vitamin D leads to the mobilization of calcium from bone, which can lead to osteoporosis, osteomalacia, and rickets. 1-3 Numerous recent studies have shown a strong association between diminished vitamin D levels and risk for falls 6 and for both vertebral and nonvertebral fractures. 7
The majority of 25-OH vitamin D (25-D) in the circulation is derived from the conversion of 7-dehydrocholesterol in the skin that is irradiated with ultraviolet radiation in the UVB range (wavelength 290 nm to 315 nm). 1-5 The extent of vitamin D formation is not tightly controlled and depends primarily on the duration and intensity of the UV irradiation. Levels produced typically reach a plateau within 30 minutes of exposure. Unfortunately, use of a sunscreen with SPF as low as 15 reduces the rate of vitamin D production by 99.9%. Overproduction of vitamin D in the skin is prevented by the photosensitive conversion of vitamin D to tachysterol or lumisterol. Vitamin D is not very water-soluble, so it must be delivered to and carried in the blood as a complex with vitamin D-binding protein. Once in the circulation, vitamin D is metabolized to 25-hydroxy vitamin D (25-D) by the liver. The 25-D form of the hormone is the principle circulating reservoir in plasma and is generally the best indicator of overall vitamin D status. 25-D is further metabolized by the kidney to produce the biologically active form of vitamin D, 1,25-dihydroxy vitamin D (1,25-D). Renal production of 1,25-D is tightly controlled by parathyroid hormone and is important in the regulation of serum calcium homeostasis.
Many tissues and cells in the body have vitamin D receptors. 1-3 It has been estimated that the expression of as much as one third of the human genome is influenced by 1,25- (OH)2 vitamin D. Many studies have demonstrated an association of vitamin D deficiency with increased risk for:
The World Health Organization's International Agency for Research on Cancer (IARC) has concluded that there is a strong link between an individual's vitamin D levels and the risk of developing colorectal cancer. 5 Studies have also revealed that low vitamin D levels are associated with an increased incidence of other malignancies, including breast cancer. 8
Vitamin D plays an integral role in calcium homeostasis and the maintenance of healthy bone. Vitamin D stimulates the absorption of calcium at the level of the intestine and may also serve to increase calcium and phosphate resorption at the kidney level. Deficiency of vitamin D leads to the mobilization of calcium from bone, which can lead to osteoporosis, osteomalacia, and rickets. 1-3 Numerous recent studies have shown a strong association between diminished vitamin D levels and risk for falls 6 and for both vertebral and nonvertebral fractures. 7