25-hydroxyvitamin D Testing in Children and Adolescents
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Defines medical necessity and coverage stance for 25-hydroxyvitamin D (25-OH-D) testing in children and adolescents (age ≥1 to ≤18), including guidance on testing in otherwise healthy and obese pediatric populations for health plans affiliated with Centene Corporation / Arizona Complete Health.
No material clinical or coverage changes in this revision.
Coverage Criteria for 25-hydroxyvitamin D Testing (Pediatrics)
Not Medically Necessary — Routine Screening in Healthy Children
Covered when ALL of the following are met:
Tests have not been demonstrated to have a clear clinical benefit
This policy does not apply to children with clinical conditions associated with reduced bone mass, recurrent low‑impact fractures, or other established clinical risk factors for vitamin D deficiency. Expert guidance recommends targeted screening of high‑risk pediatric patients based on clinical findings (for example, conditions linked to low bone mass or recurrent fractures) rather than universal screening of asymptomatic children. Providers should follow specialty guidance to identify those children for whom measurement of serum 25‑hydroxyvitamin D is appropriate.
Routine measurement of 25‑hydroxyvitamin D (25‑OH‑D) for screening healthy, asymptomatic children and adolescents age ≥1 and ≤18 is considered not medically necessary. Multiple professional bodies, including the American Academy of Pediatrics and international expert panels, advise against routine vitamin D testing in otherwise healthy children (including those who are overweight or obese) because routine testing has not demonstrated clear clinical benefit. When dietary intake is insufficient, guideline‑based vitamin D supplementation is recommended instead of routine laboratory screening.
Coding — CPT and ICD-10 Details
| 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed |
| E66.01 | Morbid (severe) obesity due to excess calories |
| E66.09 | Other obesity due to excess calories |
| E66.1 | Drug-induced obesity |
| E66.3 | Overweight |
| E66.8 | Other obesity |
| E66.81 | Obesity class |
| E66.811 | Obesity, class 1 |
| E66.812 | Obesity, class 2 |
| E66.813 | Obesity, class 3 |
| E66.89 | Other obesity not elsewhere classified |
Provider Actions, Documentation & Billing Expectations
Prior authorization may be required for CPT 82306
Ordering providers should expect that testing using CPT 82306 (Vitamin D; 25 hydroxy) for routine screening in healthy children (age ≥1 and ≤18) may not meet medical necessity; prior authorization may be required per Health Plan procedures when clinical risk factors are present.
Prefer supplementation over routine testing
For healthy children and adolescents who are not ingesting enough foods with vitamin D, guideline-based vitamin D supplementation is recommended instead of routine laboratory screening.
Document clinical indication and risk factors
Document the clinical indication and any risk factors for vitamin D deficiency when ordering 25-hydroxyvitamin D testing; routine screening in otherwise healthy children (including those who are overweight or obese) age 1–18 is considered not medically necessary.
Denial risk when billed with listed ICD-10-CM codes
Claims for CPT 82306 (Vitamin D; 25 hydroxy) billed with the ICD-10-CM diagnosis codes listed in Table 2 (examples include obesity and routine examination codes such as E66.* and Z00.129) are identified as not medically necessary and may be denied.
- Table 1 CPT: 82306 — Vitamin D; 25 hydroxy
- Table 2 ICD-10-CM examples: E66.01, E66.09, E66.3, E66.9, Z00.129, Z00.00, Z00.8, Z68.52–Z68.54
Background and Test Rationale
Measurement of 25‑OH‑D is the appropriate test to assess vitamin D status; by contrast, measurement of 1,25‑dihydroxyvitamin D (1,25‑OH2‑D) has little to no predictive value for bone health and is not recommended for routine evaluation. There is ongoing controversy regarding assay selection and cutoff thresholds to define deficiency (studies have used < 20 ng/mL as a reference in prevalence estimates), and expert panels emphasize focusing testing on clinically at‑risk groups rather than universal screening.
Definitions
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