CurrentAmbetter NevadaPolicy CP.MP.152

Measurement of Serum 1,25-dihydroxyvitamin D (CPT 82652)

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Defines clinical indications and coverage stance for measuring serum 1,25-dihydroxyvitamin D (CPT 82652) for members of Ambetter Nevada (Centene-affiliated health plans). It specifies when the test is medically necessary and when routine screening is not.

Policy Summary

PayerAmbetter Nevada

PolicyMeasurement of Serum 1,25-dihydroxyvitamin D

Policy CodePolicy CP.MP.152

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionSupport claims for CPT 82652 with a covered indication from the policy and an appropriate ICD-10 diagnosis code.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1CPT code referenced for the test

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CurrentAmbetter NevadaPolicy CP.MP.152

Measurement of Serum 1,25-dihydroxyvitamin D (CPT 82652)

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Policy Summary

PayerAmbetter Nevada

PolicyMeasurement of Serum 1,25-dihydroxyvitamin D

Policy CodePolicy CP.MP.152

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionSupport claims for CPT 82652 with a covered indication from the policy and an appropriate ICD-10 diagnosis code.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1CPT code referenced for the test

7Medically necessary indications listed

multipleICD-10 code ranges supporting coverage

annualReviewed annually

Coverage Criteria for Measurement of Serum 1,25-dihydroxyvitamin D

Medically necessary indications

Measurement of serum 1,25(OH)2D (CPT 82652) is medically necessary when used for monitoring acquired and inherited disorders of vitamin D and phosphate metabolism, including ANY of the following:

Indications list: A. Chronic kidney disease; B. Hereditary phosphate-losing disorders; C. Oncogenic osteomalacia; D. Pseudovitamin D-deficiency rickets; E. Vitamin D-resistant rickets; F. Chronic granuloma-forming disorders (e.g., sarcoidosis and some lymphomas); G. Hyperparathyroidism.

Each listed indication alone supports medical necessity.

Not medically necessary

Measurement of serum 1,25(OH)2D is not medically necessary for:

Routine screening of average risk, asymptomatic individuals.

Requests solely for routine population screening may be denied.

Measurement of serum 1,25(OH)2D (CPT 82652) for routine screening of average-risk, asymptomatic individuals is not medically necessary and is explicitly excluded from coverage. Requests solely for population-level or routine vitamin D screening without clinical indications may be denied.

The measurement of serum 1,25(OH)2D should not be used as a screening test in asymptomatic persons at average risk. The policy specifies that use of this assay for routine screening of average-risk, asymptomatic individuals does not meet medical necessity criteria.

Coding — CPT/ICD-10/HCPCS

Covered CPT CodesCPTCovered

82652

Vitamin D; 1,25 dihydroxy, includes fraction(s), if performed

HCPCS CodesHCPCS

No codes listed

ICD-10-CM Diagnosis Codes that Support Coverage CriteriaICD-10Covered

A15.0-A19.9	Tuberculosis (range)
C81.00-C81.99	Hodgkin lymphoma (range)
C82.00-C82.99	Follicular lymphoma (range)
C83.00-C83.99	Non-follicular lymphoma (range)
C84.00-C84.99	Mature T/NK-cell lymphomas (range)
C88.0-C88.9	Malignant immunoproliferative diseases and certain other B-cell lymphomas (range)
D86.0-D86.9	Sarcoidosis (range)
E20.0	Idiopathic hypoparathyroidism
E20.8	Other hypoparathyroidism
E21.0-E21.5	Hyperparathyroidism and other disorders of parathyroid gland (range)

1–10 of 20

1/2

Provider Actions, Billing and Documentation

Billing Rule

Billing and coding requirements for CPT 82652

Support CPT 82652 with a covered indication. Claims for CPT 82652 (Measurement of serum 1,25-dihydroxyvitamin D) must be supported by an appropriate covered clinical indication and an ICD-10 diagnosis code from the supported ranges. Include relevant clinical documentation showing the indication (for example: chronic kidney disease, hereditary phosphate-losing disorders, oncogenic osteomalacia, pseudovitamin D-deficiency rickets, vitamin D–resistant rickets, chronic granuloma-forming disorders such as sarcoidosis or certain lymphomas, or hyperparathyroidism).

Affected CPT: 82652 (Vitamin D; 1,25 dihydroxy)
Supported ICD-10 ranges: A15.0–A19.9; C81.00–C81.99; C82.00–C82.99; C83.00–C83.99; C84.00–C84.99; C88.0–C88.9; D86.0–D86.9; E20.0; E20.8; E21.0–E21.5; E55.0; E83.30–E83.39; E83.50–E83.59; E89.2; M83.8; M83.9; N18.1–N18.9; N25.0; N25.81; P37.0

Documentation Required

Background and Clinical Context

25-hydroxyvitamin D (25(OH)D) is the major circulating form and is the preferred measure of vitamin D status, whereas 1,25-dihydroxyvitamin D (1,25(OH)2D) is the hormonally active form. Because 1,25(OH)2D has a short half-life and does not reflect body vitamin D reserves, its measurement is reserved for evaluation and monitoring of specific disorders of vitamin D and phosphate metabolism (for example, chronic kidney disease, hereditary phosphate-losing disorders, oncogenic osteomalacia, rickets variants, granulomatous diseases, and hyperparathyroidism) rather than routine status screening.

Definitions

25(OH)D — Major circulating form of vitamin D

Term25-hydroxyvitamin D [25(OH)D] (calcidiol)

RoleMajor circulating form of vitamin D; best indicator to assess vitamin D status.

Half-lifeApproximately 2–3 weeks; more stable for monitoring vitamin D reserves.

Clinical usePreferred test to determine vitamin D status in individuals at risk for deficiency.

Contrast with 1,25(OH)2DCirculates at much higher concentrations than 1,25(OH)2D and reflects vitamin D stores, unlike the active form.

1,25(OH)2D — Active form of vitamin D

Term

Revision History

2017-11-17policy_development

Policy developed (revision date recorded).

2017-12-17approval

Policy approved following development in November 2017; references reviewed and updated.

2019-11-19revision

References reviewed and updated and code E20.00 corrected to E20.0.

Policy Summary

PayerAmbetter Nevada

PolicyMeasurement of Serum 1,25-dihydroxyvitamin D

Policy CodePolicy CP.MP.152

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionSupport claims for CPT 82652 with a covered indication from the policy and an appropriate ICD-10 diagnosis code.

SourceLink

On This Page

Documentation and coding guidance

Provider documentation should clearly link the test order to one of the covered clinical indications and include the specific ICD-10 code used for billing. Failure to document a covered indication and the supporting diagnosis may result in claim denial.

Use CPT 82652 for billing the 1,25-dihydroxyvitamin D assay.
Include one ICD-10 code from the supported list on the claim.
Retain clinical notes that demonstrate the condition being monitored (e.g., CKD stage, diagnosis of sarcoidosis or lymphoma, documented rickets variant, hyperparathyroidism).

Denial Risk

Routine screening not covered

Routine screening of average‑risk, asymptomatic individuals is not medically necessary and is a likely basis for denial. Orders for serum 1,25(OH)2D for routine population screening without documented symptoms or a qualifying condition may be denied.

Not medically necessary: routine screening of average‑risk, asymptomatic individuals

Prior Authorization

Provider action - confirm indication before ordering

Provider-action: ensure test requests meet the medical necessity criteria before submission to avoid delays or denials.

Confirm one of the covered indications is present and documented.
Attach or record the supporting ICD-10 diagnosis code from the policy list.
Use CPT 82652 when billing for the assay and follow any plan-specific prior authorization processes if applicable.

1,25-dihydroxyvitamin D [1,25(OH)2D] (calcitriol)

RoleActive form of vitamin D used in calcium and phosphate homeostasis.

Half-lifeShort — about 4 hours; circulates at much lower concentrations than 25(OH)D.

LimitationsNot reflective of vitamin D reserves and may be normal or elevated in vitamin D deficiency due to secondary hyperparathyroidism.

Appropriate useUseful for select metabolic disorders and monitoring acquired or inherited disorders of vitamin D and phosphate metabolism (per policy indications).

2020-10-20revision

References reviewed and updated; terminology changed from 'member' to 'member/enrollee' throughout policy; header fields clarified; ICD-10 range for tuberculosis expanded and N25.81 added to supporting codes.

2021-10-21approval

Annual review completed; references reviewed, reformatted, and updated; reviewed by specialist.

2022-09-22revision

Annual review; references reviewed and updated.

2023-09-23revision

Annual review; added criteria I.G. Hyperparathyroidism and ICD-10 codes E89.2, M83.8, and M83.9; references reviewed and updated after internal and external specialist review.

2024-09-24revision

Annual review; references reviewed and updated with external specialist review.

2025-09-25revisionLatest

Annual review; references reviewed and updated with external specialist review.