CurrentArizona Complete HealthPolicy CP.MP.152

Measurement of Serum 1,25-dihydroxyvitamin D (calcitriol)

Defines when measurement of serum 1,25(OH)2D (CPT 82652) is medically necessary versus not medically necessary for routine screening, for members of Arizona Complete Health (Centene-affiliated health plans). Affects ordering providers and billing for vitamin D testing.

Policy Summary

PayerArizona Complete Health

PolicyMeasurement of Serum 1,25-dihydroxyvitamin D (calcitriol)

Policy CodePolicy CP.MP.152

Change TypeAnnual review — no material changes

Effective Date

Next Review Date

Key ActionWhen ordering CPT 82652, include supporting ICD-10 diagnosis codes that substantiate one of the listed medically necessary indications.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

82652Referenced test code

7+Medically necessary indications

ICD-10 rangesSupporting diagnosis sets

2017-2025Revision history

Coverage Criteria for Measurement of Serum 1,25(OH)2D

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Medically necessary indications

Covered when ANY of the following indications are present (measurement of serum 1,25(OH)2D is medically necessary):

Indication: Chronic kidney disease
Indication: Hereditary phosphate-losing disorders
Indication: Oncogenic osteomalacia
Indication: Pseudovitamin D-deficiency rickets
Indication: Vitamin D-resistant rickets
Indication: Chronic granuloma-forming disorders (e.g., sarcoidosis and some lymphomas)
Indication: Hyperparathyroidism

Note: Each condition listed above individually meets criteria for medical necessity for measurement of serum 1,25(OH)2D.

Coding

Referenced CPT CodesCPT

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-10

A15.0-A19.9	Tuberculosis (ICD-10 range listed)
C81.00-C81.99	Hodgkin lymphoma
C82.00-C82.99	Follicular lymphoma
C83.00-C83.99	Non-follicular lymphoma
C84.00-C84.99	Mature T/NK-cell lymphomas
C88.0-C88.9	Malignant immunoproliferative diseases and certain other B-cell lymphomas
D86.0-D86.9	Sarcoidosis
E20.0	Idiopathic hypoparathyroidism
E20.8	Other hypoparathyroidism
E21.0-E21.5	Hyperparathyroidism and other disorders of parathyroid gland

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Provider Actions and Billing Requirements

Prior Authorization

Prior Authorization / Coverage Headline

Measurement of serum 1,25(OH)2D (CPT 82652) is covered when billed with diagnoses supporting the listed indications; routine population screening of average-risk asymptomatic individuals is not covered.

Covered when ordered for monitoring acquired or inherited disorders of vitamin D and phosphate metabolism, including but not limited to: chronic kidney disease; hereditary phosphate‑losing disorders; oncogenic osteomalacia; pseudovitamin D‑deficiency rickets; vitamin D‑resistant rickets; chronic granuloma‑forming disorders (e.g., sarcoidosis, some lymphomas); hyperparathyroidism.
Routine screening for average‑risk, asymptomatic individuals is considered not medically necessary and will be denied.

Documentation Required

Provider Guidance

Providers must include documentation in the medical record supporting the clinical indication for ordering CPT 82652. Submit relevant clinical notes, laboratory findings, and treatment history as needed to justify medical necessity.

Include reason for test and relevant signs/symptoms or diagnosis in the chart.
Attach supporting diagnosis codes from the ICD‑10 ranges listed below when submitting claims for CPT 82652.

Billing Rule

Attach Supporting ICD-10 Diagnosis

Attach one or more of the following ICD‑10 diagnosis codes or ranges when billing CPT 82652 to support coverage under the indications above.

A15.0–A19.9 (Tuberculosis)
C81.00–C81.99, C82.00–C82.99, C83.00–C83.99, C84.00–C84.99, C88.0–C88.9 (Hodgkin and certain non‑Hodgkin lymphomas and related malignancies)
D86.0–D86.9 (Sarcoidosis)
E20.0, E20.8, E21.0–E21.5 (Hypoparathyroidism and hyperparathyroidism disorders)
E55.0 (Rickets, active)
E83.30–E83.39 (Disorders of phosphorus metabolism and phosphatases)
E83.50–E83.59 (Disorders of calcium metabolism)
E89.2 (Postprocedural hypoparathyroidism)
M83.8–M83.9 (Adult osteomalacia)
N18.1–N18.9 (Chronic kidney disease)
N25.0, N25.81 (Renal osteodystrophy; secondary hyperparathyroidism of renal origin)
P37.0 (Congenital tuberculosis)

Denial Risk

Routine Screening Not Medically Necessary

Tests ordered for routine population screening of average‑risk, asymptomatic individuals are not medically necessary and are not covered. Claims for CPT 82652 billed without supporting diagnoses from the ranges above or without adequate documentation of clinical indication may be denied.

Do not order CPT 82652 for general population screening or for asymptomatic patients without clinical risk factors.
When denied, appeals must include clinical documentation demonstrating one of the covered indications.

Background

25‑hydroxyvitamin D [25(OH)D] is the major circulating form used to assess overall vitamin D status; by contrast, 1,25‑dihydroxyvitamin D [1,25(OH)2D] (calcitriol) is the hormonally active form that circulates at low concentrations and has a short half‑life. Measurement of 1,25(OH)2D is useful in selected acquired and inherited disorders of vitamin D and phosphate metabolism — for example, chronic kidney disease, hereditary phosphate‑losing disorders, oncogenic osteomalacia, pseudovitamin D‑deficiency rickets, vitamin D‑resistant rickets, chronic granuloma‑forming disorders (e.g., sarcoidosis and some lymphomas), and hyperparathyroidism — where assessment of the active metabolite informs diagnosis or management. Because 1,25(OH)2D does not reflect vitamin D reserves, it is not appropriate for routine population screening of asymptomatic, average‑risk individuals.

Definitions

25(OH)D (calcidiol) — key facts

Definition25-hydroxyvitamin D (25[OH]D, calcidiol) — the major circulating form of vitamin D used to determine vitamin D status.

Clinical relevanceBest method to determine vitamin D status in individuals at risk is measurement of serum 25(OH)D rather than 1,25(OH)2D.

Half-lifeApproximately 2–3 weeks.

RoleMain circulating form and preferred analyte to monitor vitamin D reserves; reflects vitamin D stores.

Contrast with active formCirculates at much higher concentrations and longer half-life than 1,25(OH)2D; not subject to rapid PTH-driven fluctuations.

1,25(OH)2D (calcitriol) — key facts

Definition1,25-dihydroxyvitamin D (1,25[OH]2D, calcitriol) — the active form of vitamin D.

Circulating concentrationPresent at much lower circulating concentrations compared with 25(OH)D.

Half-lifeShort half-life (~4 hours).

RegulationConcentration is regulated by parathyroid hormone (PTH), serum calcium, and phosphorus; susceptible to rapid fluctuations.

Clinical utilityNot useful for routine assessment of vitamin D status or monitoring vitamin D reserves; measurement is appropriate only in selected disorders of vitamin D and phosphate metabolism.

Revision History

2017-11-17Policy developed

Policy developed (initial), with approval recorded in December 2017 and references reviewed and updated.

2019-11-19Revision

References reviewed and updated; corrected code E20.00 to E20.0 and updated approval date.

2020-10Revision

References reviewed and updated; terminology changed from 'member' to 'member/enrollee' throughout the policy and header labels adjusted; annual review performed.

2021-10Annual review

Annual review with expansion of ICD-10 tuberculosis range to A15.0-A19.9 and addition of N25.81 to supporting diagnosis codes; header and revision log labels clarified; references reviewed and updated with specialist review.

2022-09Annual review

Annual review; references reviewed and updated.

2023-09Annual review and criteria update

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

2024-09Annual review

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

2025-09Annual reviewLatest

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