Medical Policy Implementation: Vitamin D Testing

Effective January 4, 2016, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for vitamin D testing.

According to the guidelines of our medical policy, Vitamin D Testing:

• Testing for vitamin D (i.e., 25 hydroxyvitamin D or 25 OHD) is considered medically necessary in members considered at high risk for vitamin D deficiency or in members with disease(s) or condition(s) associated with decreased 25 OHD or for members with documented vitamin D deficiency on replacement therapy to monitor efficacy of treatment.
• Testing for vitamin D (i.e., 1, 25 hydroxyvitamin D or 1, 25 OH2D) is considered medically necessary for the evaluation of members with a clinically documented underlying disease or condition associated with increased or decreased 1,25 (OH)2D including: Hypercalcemia with a low parathyroid hormone; Acquired and/or inherited disorders in the metabolism of 25 OHD and phosphate; Tumor induced osteomalacia (oncogenic osteomalacia); Hereditary phosphate-losing disorders; Chronic kidney disease and/or renal insufficiency;Vitamin D-dependent rickets type 1 (also known as pseudo-vitamin D deficient rickets); Vitamin D-resistant rickets;Chronic granuloma-forming disorders (e.g., sarcoidosis, tuberculosis and some lymphomas); Osteogenesis imperfecta; or Osteopetrosis.
• Other than in very complex cases (e.g., hypercalcemia with reportedly low endogenous levels of 25 hydroxyvitamin D (25 OHD)), there are rarely indications for ordering both 25-hydroxyvitamin D and 1, 25-dihydroxyvitamin D (1, 25 OH2D) on the same specimen at the same time.
• Routine testing for vitamin D in members not at high risk for vitamin D deficiency is not considered medically necessary.
• Routine testing for vitamin D deficiency for non-skeletal diseases (e.g., cardiovascular disease, cancer and autoimmune disease) is considered investigational.

Based on the guidelines of our medical policy, Vitamin D Testing, AND the submitted diagnosis or diagnoses code(s), CPT®codes 82306 or 82652 submitted on claims for services provided on and after January 4, 2016 may be denied as experimental or investigational services.

Review this revised policy in our online Medical Policy Manual.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after January 4, 2016.

CPT® is a registered mark of the American Medical Association.