CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLAB010

Vitamin B12 and Methylmalonic Acid Testing

Defines Blue Cross Blue Shield of New Mexico reimbursement criteria for serum total vitamin B12 and methylmalonic acid testing, who may be eligible, and situations that are not reimbursable; applies to providers submitting lab claims to BCBSNM.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyVitamin B12 and Methylmalonic Acid Testing

Policy CodePolicy CPCPLAB010

Change TypeMaterial updates to reimbursement criteria and exclusions

Effective DateApr 15, 2025

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to claim review.

SourceLink

POLICY UPDATE CHANGES

Added a three month testing frequency for all vitamin B testing/screening resulting in a main criterion that total vitamin B12 testing may be reimbursable once every three months for specified situations.

Added new criterion: For all other situations not described above, total vitamin B12 (serum cobalamin) testing is not reimbursable.

Holotranscobalamin testing declared not reimbursable for screening, testing, or confirmation of vitamin B12 deficiency.

once/3momax frequency for B12 test

Holotranscobalaminexplicitly excluded test

suspected deficiencyMMA reimbursable when

CPCPLAB010policy id

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyVitamin B12 and Methylmalonic Acid Testing

Policy CodePolicy CPCPLAB010

Change TypeMaterial updates to reimbursement criteria and exclusions

Effective DateApr 15, 2025

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to claim review.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Reimbursement Criteria

Reimbursement criteria for vitamin B12 and methylmalonic acid testing

Total vitamin B12 (serum cobalamin) testing may be reimbursable once every three months for the specified indications; methylmalonic acid testing may be reimbursable in certain scenarios. Certain tests and situations are not reimbursable.

ALL of the following

ONE of:
- ALL of the following
  - Cutaneous: hyperpigmentation, jaundice, vitiligo.
  - Gastrointestinal: glossitis.
  - Hematologic: anemia (macrocytic, megaloblastic), leukopenia, pancytopenia, thrombocytopenia, thrombocytosis.
  - Neuropsychiatric: areflexia; cognitive impairment (including dementia-like symptoms and acute psychosis); gait abnormalities; irritability; loss of proprioception and vibratory sense; olfactory impairment; peripheral neuropathy.
- Individuals undergoing treatment for vitamin B12 deficiency.
- ALL of the following
  - Decreased ileal absorption: Crohn's disease; ileal resection; tapeworm infection; prior or planned bariatric procedures (Roux-en-Y gastric bypass, sleeve gastrectomy, biliopancreatic diversion/duodenal switch).
  - Decreased intrinsic factor: atrophic gastritis; pernicious anemia; postgastrectomy syndrome.
  - Transcobalamin II deficiency.
  - Inadequate intake: alcohol abuse; age >75 years or elderly individuals being evaluated for dementia; vegans or strict vegetarians (including exclusively breastfed infants of vegetarian/vegan mothers); eating disorders.
  - Prolonged medication use: histamine H2 blocker use >12 months; metformin use >4 months; proton pump inhibitor use >12 months.

ALL of the following

ANY of the following
- Asymptomatic high-risk individuals with low-normal vitamin B12 levels or when vitamin B12 deficiency is suspected despite a normal or low-normal serum vitamin B12 level (used to confirm deficiency).
- Evaluation of inborn errors of metabolism.

ALL of the following

Healthy, asymptomatic individuals: screening for vitamin B12 deficiency is not reimbursable.
Homocysteine testing is not reimbursable for confirmation of vitamin B12 deficiency.
Holotranscobalamin testing is not reimbursable for screening, testing, or confirmation of vitamin B12 deficiency.
For all other situations not described above, total vitamin B12 (serum cobalamin) testing is not reimbursable.

Plan documents or provider contracts govern if there is a conflict with this policy.

Procedure Codes and Frequency

Procedure codes (not all-inclusive)CPT

84999

Unlisted chemistry procedure (code added to policy in 03/15/2024 update)

Testing frequency

Maximum reimbursable frequencyTotal vitamin B12 (serum cobalamin) testing may be reimbursed once every three months for listed indications.

Applicable situations (summary)Individuals with signs or symptoms of B12 deficiency; individuals undergoing treatment for B12 deficiency; individuals with specified risk factors (see policy).

NoticesFor all other situations not described in the policy, total vitamin B12 testing is not reimbursable.

Documentation and Claim Review

Documentation Required

Documentation and claim review — submit accurate documentation and respond to requests

Providers must submit accurate documentation of services performed and submit claims using valid code combinations from HIPAA-approved code sets. Claims are subject to code edit protocols and claim review; upon request, providers may be asked to submit additional documentation. Plan documents or provider contracts govern if they conflict with this policy.

Submit claims using valid HIPAA-approved code combinations and industry-standard coding guidelines (CPT, HCPCS, ICD-10-CM/PCS, UB, NDC, DRG rules, CCI edits).
Claims are subject to code edit protocols and review against benefit coverage, provider contract terms, medical and coding policies, and coding software logic.
Provide additional documentation upon request to support the claim.

Test Definitions

Total vitamin B12 testing (definition)

Test name (term)Total vitamin B12 testing (serum cobalamin)

DescriptionMeasurement of serum total vitamin B12 (cobalamin) used to evaluate for vitamin B12 deficiency.

Primary use in policyMay be reimbursable once every three months when clinical signs/symptoms, treatment monitoring, or specified risk factors are present.

Methylmalonic acid testing (definition and reimbursable use)

Test name (term)Methylmalonic acid (MMA) testing

Clinical useUsed to confirm vitamin B12 deficiency when serum B12 is low-normal or deficiency is suspected despite normal/low-normal B12 levels.