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Reimbursement Policy Implementation: Vitamin D Testing

Effective June 15, 2020, Horizon BCBSNJ will change the way we consider certain claims based on the guidelines of our reimbursement policy Vitamin D Testing.

We encourage you to review our Vitamin D Testing policy.

Claims submitted for services provided on and after June 15, 2020 to patients enrolled in Horizon BCBSNJ fully insured Commercial plans and Administrative Services Only (ASO) employer groups will be processed as follows.

When submitted by any provider with a vitamin D deficiency and/or the appropriate high-risk diagnosis code(s), Horizon BCBSNJ will consider vitamin D testing services (represented by CPT® procedure codes 82306, 82652 and 0038U) up to a maximum limit of four tests per year. This testing limit includes initial measurement and subsequent measurement three to four months later to assess dose adequacy.

Participating providers cannot balance bill members for vitamin D testing services denied for exceeding the four per year limit.

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 services on and after June 15, 2020, 2020.

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

Published on: March 16, 2020, 02:34 a.m. ET
Last updated on: April 28, 2021, 05:16 a.m. ET