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.

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.

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.