Procedure Code: 82306
Group 1 Codes:
82306 VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED
82652 VITAMIN D; 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED
LCD Description:Vitamin D is a hormone, synthesized by the skin and metabolized by the kidney to an active hormone, calcitriol. An excess of vitamin D may lead to hypercalcemia. Vitamin D deficiency may lead to a variety of disorders. This LCD identifies the indications and limitations of Medicare coverage and reimbursement for these services
ICD10 DESCRIPTION
E55.9 Vitamin D deficiency, unspecified
E20.0 Idiopathic hypoparathyroidism
E20.8 Other hypoparathyroidism
Hypoparathyroidism, unspecified E20.9
E21.0 Primary hyperparathyroidism
Secondary hyperparathyroidism, not elsewhere classified E21.1
E21.2 Other hyperparathyroidism
Hyperparathyroidism, unspecified E21.3
Rickets, active E55.0
Vitamin D deficiency, unspecified
Medicare generally considers vitamin assay panels (more than one vitamin assay) a screening procedure and therefore, non-covered. Similarly, assays for micronutrient testing for nutritional deficiencies that include multiple tests for vitamins, minerals, antioxidants and various metabolic functions are never necessary. Medicare reimburses for covered clinical laboratory studies that are reasonable and necessary for the diagnosis or treatment of an illness. Many vitamin deficiency problems can be determined from a comprehensive history and physical examination. Any diagnostic evaluation should be targeted at the specific vitamin deficiency suspected and not a general screen. Most vitamin deficiencies are nutritional in origin and may be corrected with supplemented vitamins.
Most vitamin deficiencies are suggested by specific clinical findings. The presence of those specific clinical findings may prompt laboratory testing for evidence of a deficiency of that specific vitamin. Certain other clinical states may also lead to vitamin deficiencies (malabsorption syndromes, etc).
Limitations:
For Medicare beneficiaries, screening tests are governed by statute (Social Security Act 1861(nn)). Vitamin or micronutrient testing may not be used for routine screening.
Once a beneficiary has been shown to be vitamin deficient, further testing is medically necessary only to ensure adequate replacement has been accomplished. Thereafter, annual testing may be appropriate depending upon the indication and other mitigating factors.
Once a beneficiary has been shown to be vitamin deficient, further testing is medically necessary only to ensure adequate replacement has been accomplished. Thereafter, annual testing may be appropriate depending upon the indication and other mitigating factors.
Assays of selenium (84255), functional intracellular analysis (84999) or total antioxidant function (84999) are non-covered services. Assays of vitamin testing, not otherwise classified (84591), are not covered since all clinically relevant vitamins have specific assays.
The following are pertinent laboratory tests for which frequency limitations will be specified [note this should be all the CPT codes in the list below, except for those that are non-covered]:
- Vitamins and metabolic function assays: 25-OH Vitamin D-3, Carnitine, Vitamin B-12, Folic Acid (Serum), Homocystine, Vitamin B-6, Vitamin B-2, Vitamin B-1, Vitamin E, Fibrinogen, High-Sensitivity C-Reactive Protein and Lipoprotein-associated phospholipase A2 (Lp-PLA2); Vitamin A; Vitamin K; and Ascorbic acid..
- Additional inclusion of Vitamin D (with limited coverage not otherwise specified).
Notice: This LCD imposes diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.
To be covered under Medicare, a service shall be reasonable and necessary. When appropriate, contractors shall describe the circumstances under which the proposed LCD for the service is considered reasonable and necessary under Section 1862(a)(1)(A). Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:
- Safe and effective.
- Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
- Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
- Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
- Furnished in a setting appropriate to the patient’s medical needs and condition.
- Ordered and furnished by qualified personnel.
- One that meets, but does not exceed, the patient’s medical need.
- At least as beneficial as an existing and available medically appropriate alternative.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12X, 13X, 14X, 18X, 21X, 22X, 23X, 71X, 72X, 75X, 77X, 83X, 85X
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
Note: TrailBlazer has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this LCD. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual Publication 100-04, Claims Processing Manual, for further guidance.
030X
CPT/HCPCS Codes
Note:
Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web.
82180© Assay of ascorbic acid
82306© Vitamin D, 25-hydroxy
Note: Code 82306 includes fractions, if performed.
82379© Carnitine
82607© Cyanocobalamin, (Vitamin B-12)
82652© Vitamin D 1, 25-dihydroxy
Note: Code 82652 includes fractions, if performed.
82746© Folic Acid
83090© Homocysteine
83698© Assay lipoprotein pla2
84207© Pyridoxal phosphate (Vitamin B-6)
84252© Riboflavin (Vitamin B-2)
84425© Thiamin (Vitamin B-1)
84446© Tocopherol
84590© Assay of Vitamin A
84591© Assay of NOS vitamin
84597© Assay of Vitamin K
85385© Fibrinogen, antigen
86141© C-reactive protein, hs
86352© Cell function assay w/stim
86353© Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis
CPT/HCPCS Codes
Note:
Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web.
82180© Assay of ascorbic acid
82306© Vitamin D, 25-hydroxy
Note: Code 82306 includes fractions, if performed.
82379© Carnitine
82607© Cyanocobalamin, (Vitamin B-12)
82652© Vitamin D 1, 25-dihydroxy
Note: Code 82652 includes fractions, if performed.
82746© Folic Acid
83090© Homocysteine
83698© Assay lipoprotein pla2
84207© Pyridoxal phosphate (Vitamin B-6)
84252© Riboflavin (Vitamin B-2)
84425© Thiamin (Vitamin B-1)
84446© Tocopherol
84590© Assay of Vitamin A
84591© Assay of NOS vitamin
84597© Assay of Vitamin K
85385© Fibrinogen, antigen
86141© C-reactive protein, hs
86352© Cell function assay w/stim
86353© Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis
Billing and Coding Guidelines
ALL these codes are required CLIA certification and QW Modifier
Vitamin D Assays (CPT code 82306)
LCD Description:Vitamin D is a hormone, synthesized by the skin and metabolized by the kidney to an active hormone, calcitriol. An excess of vitamin D may lead to hypercalcemia. Vitamin D deficiency may lead to a variety of disorders. This LCD identifies the indications and limitations of Medicare coverage and reimbursement for these services.
ALL these codes are required CLIA certification and QW Modifier
Vitamin D Assays (CPT code 82306)
LCD Description:Vitamin D is a hormone, synthesized by the skin and metabolized by the kidney to an active hormone, calcitriol. An excess of vitamin D may lead to hypercalcemia. Vitamin D deficiency may lead to a variety of disorders. This LCD identifies the indications and limitations of Medicare coverage and reimbursement for these services.
VITAMIN D 25 HYDROXY (CPT 82306)
ICD-10 Description ICD-10 ICD-9
Age-Related Osteoporosis without Current Pathological Fracture M81.0 733.00
Age-Related Osteoporosis without Current Pathological Fracture M81.0 733.01
Hypercalcemia E83.52 275.42
Hypocalcemia E83.51 275.41
Other Osteoporosis without Current Pathological Fracture M81.8 733.02
Other Osteoporosis without Current Pathological Fracture M81.8 733.09
Vitamin D Deficiency, Unspecified E55.9 268.9
ICD-10 Description ICD-10 ICD-9
Age-Related Osteoporosis without Current Pathological Fracture M81.0 733.00
Age-Related Osteoporosis without Current Pathological Fracture M81.0 733.01
Hypercalcemia E83.52 275.42
Hypocalcemia E83.51 275.41
Other Osteoporosis without Current Pathological Fracture M81.8 733.02
Other Osteoporosis without Current Pathological Fracture M81.8 733.09
Vitamin D Deficiency, Unspecified E55.9 268.9
** Z00 Encounter for general examination without complaint, suspected or reported diagnosis
** Z00.0 Encounter for general adult medical examination
** Z00.00 Encounter for general adult medical examination without abnormal findings
** Z00.1 Encounter for newborn, infant and child health examinations
** Z00.11 Newborn health examination
** Z00.110 Health examination for newborn under eight days old
** Z00.111 Health examination for newborn 8 to 28 days old
** Z00.12 Encounter for routine child health examination
** Z00.129 Encounter for routine child health examination without abnormal findings
** Z00.8 Encounter for other general examination
CPT code 84591 and 82306 are not paid when billing together.
ICD-9-CM Codes That Support Medical Necessity
The CPT/HCPCS codes included in this LCD will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
Medicare is establishing the following limited coverage for CPT codes 82306 and 82652:
Covered for:
|
252.00–252.02
|
Disorders of parathyroid gland
|
|
252.08
|
Other hyperparathyroidism
|
|
252.1
|
Hypoparathyroidism
|
|
268.0
|
Rickets, active
|
|
268.2
|
Osteomalacia, unspecified
|
|
268.9
|
Unspecified vitamin D deficiency
|
|
275.3
|
Disorders of phosphorus metabolism
|
|
275.41–275.42
|
Disorders of calcium metabolism
|
|
585.3–585.6
|
Chronic kidney disease (CKD)
|
|
588.81
|
Secondary hyperparathyroidism (of renal origin)
|
|
733.00–733.03
|
Osteoporosis
|
|
733.09
|
Other osteoporosis
|
|
733.90
|
Disorder of bone and cartilage, unspecified
|
Medicare is establishing the following limited coverage for CPT code 82379:
Covered for:
|
277.81–277.84
|
Carnitine deficiency
|
|
285.21
|
Anemia in chronic kidney disease
|
|
458.21
|
Hypotension of hemodialysis
|
Medicare is establishing the following limited coverage for CPT codes 82607, 82746 and 83090:
Covered for:
|
040.2
|
Whipple’s Disease
|
|
261
|
Nutritional marasmus
|
|
262
|
Other severe protein calorie malnutrition
|
|
263.0
|
Malnutrition of moderate degree
|
|
263.2
|
Arrested development following protein-calorie malnutrition
|
|
263.8-263.9
|
Other protein-calorie malnutrition
|
|
266.2
|
Other B complex deficiencies
|
|
270.4
|
Disturbances of sulphur bearing amino-acid metabolism
|
|
281.0-281.3
|
Pernicious anemia
|
|
281.9
|
Unspecified deficiency anemia
|
|
287.5
|
Thrombocytopenia, unspecified
|
|
290.0
|
Senile dementia, uncomplicated
|
|
303.91-303.92
|
Other and unspecified alcohol dependence
|
|
331.0
|
Alzheimer’s Disease
|
|
333.99
|
Other and unspecified extrapyramidal diseases and abnormal movement disorders
|
|
356.4
|
Idiopathic progressive polyneuropathy
|
|
356.9
|
Peripheral neuropathy, unspecified
|
|
529.0
|
Glossitis
|
|
529.6
|
Glossodynia
|
|
536.0
|
Achlorhydria
|
|
555.0–555.2
|
Regional enteritis
|
|
555.9
|
Regional enteritis, unspecified site
|
|
579.0–579.4
|
Intestinal Malabsorption
|
|
579.8–579.9
|
Intestinal Malabsorption
|
|
780.93
|
Memory loss
|
|
780.99*
|
Other general symptoms
|
|
*Note: Use to identify altered mental status
|
|
|
781.2
|
Ataxia
|
|
781.3
|
Paresthesia
|
|
782.0
|
Sensory loss
|
|
V12.1
|
Personal history of nutrition deficiency
|
|
V45.11
|
Renal dialysis status
|
|
V45.3
|
Intestinal bypass or anastomosis status
|
|
V58.11
|
Encounter for antineoplastic chemotherapy
|
|
V58.69
|
Long-term (current) use of other medications
|
Medicare is establishing the following limited coverage for CPT code 84207:
Covered for:
|
266.1
|
Vitamin B-6 deficiency
|
|
285.0
|
Sideroblastic anemia
|
|
333.99
|
Other and unspecified extrapyramidal diseases and abnormal movement disorders
|
|
356.9
|
Peripheral neuropathy, unspecified
|
|
529.0
|
Glossitis
|
Medicare is establishing the following limited coverage for CPT code 85385:
Covered for:
|
286.3
|
Congenital deficiency of other clotting factors
|
|
286.6-286.7
|
Coagulation defects
|
|
287.30–287.33
|
Primary Thrombocytopenia
|
|
287.41
|
Posttransfusion purpura
|
|
287.49
|
Other secondary thrombocytopenia
|
|
287.5
|
Secondary thrombocytopenia
|
|
790.92
|
Abnormal Coagulation profile
|
Medicare is establishing the following limited coverage for CPT codes 86352 and 86353:
Covered for:
|
279.10-279.13
|
Deficiency of cell-medicated immunity
|
|
996.81-996.87
|
Complications of transplanted organ
|
|
V42.0
|
Organ or tissue replaced by transplant, kidney
|
|
V42.1
|
Organ or tissue replaced by transplant, heart
|
|
V42.6
|
Organ or tissue replaced by transplant, lung
|
|
V42.7
|
Organ or tissue replaced by transplant, liver
|
|
V42.81
|
Organ or tissue replaced by transplant, bone marrow
|
|
V42.83
|
Organ or tissue replaced by transplant, pancreas
|
|
V42.84
|
Organ or tissue replaced by transplant, intestine
|
Medicare is establishing the following limited coverage for CPT code 86141, and 83698:
Covered for:
|
414.01
|
Coronary atherosclerosis of native coronary artery
|
Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims.
Diagnoses That Support Medical Necessity
Note: Limited coverage is not being established, at this time, for the remaining CPT codes (82180, 84252, 84425 and 84446, 84590 and 84597). See the “Utilization Guidelines” section for frequency limitations.
Documentation Requirements
Documentation supporting medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon request.
Utilization Guidelines
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.
- Carnitine (82379) may be tested up to three times per year to account for baseline assay followed by evaluations at six-month increments (adapted from “Levocarnitine” NCD).
- Vitamin B-12 (82607) and folate (82746) can be tested up to four times per year for malabsorption syndromes (579.9) or deficiency disorders (266.2, 281.1 and 281.2).
- Vitamin B-12 (82607) can only be tested more frequently than four times per year for postsurgical malabsorption (579.3).
- 25-OH Vitamin D-3 (82306) may be tested up to four times per year for Vitamin D deficiencies (268.0–268.9).
- Fibrinogen, antigen (85385) may be tested up to four times per year for low platelet diagnoses (287.30–287.33, 287.41, 287.49, 287.5).
- Medicare will not cover more than two high-sensitivity C-reactive protein (86141) tests per year per beneficiary. This allows for baseline testing and six-month follow-up tests for statin therapeutic management.
- The same frequency edit (two tests per year per beneficiary) will be applied to Lipoprotein-associated phospholipase A2 (Lp-PLA2) used in the management of patients with coronary artery disease.
- Cell function assay with stimulation (86352) and Lymphocyte transformation assays (86353) will not be subjectedto any frequency edits.
Notice: This LCD imposes utilization guideline limitations. Despite Medicare’s allowing up to these maximums, each patient’s condition and response to treatment must medically warrant the number of services reported for payment. Medicare requires the medical necessity for each service reported to be clearly demonstrated in the patient’s medical record. Medicare expects that patients will not routinely require the maximum allowable number of services.
