ModifiedBlue Cross Blue Shield - New MexicoPolicy CPCPLAB003

Vitamin D Testing

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Defines Blue Cross Blue Shield of New Mexico reimbursement criteria for serum vitamin D testing (25-hydroxyvitamin D and 1,25-dihydroxyvitamin D), who may be eligible for payment, and tests/services that are not reimbursable.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyVitamin D Testing

Policy CodePolicy CPCPLAB003

Change TypeReimbursement language and frequency limit added

Effective DateMay 1, 2026

Last ReviewJan 12, 2026

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request.

SourceLink

POLICY UPDATE CHANGES

Added 'or for individuals with vitamin D deficiency' and '(no more than one test every six months)' to #1, resulting in removal of statement #3.

Under Note 1, added 'chemotherapy' to letter N for clarity as a medication known to lower vitamin D levels.

References revised and literature review updates made on multiple dates.

1/6mofrequency limit added

3procedure codes referenced

≥40listed indications

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ModifiedBlue Cross Blue Shield - New MexicoPolicy CPCPLAB003

Vitamin D Testing

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Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyVitamin D Testing

Policy CodePolicy CPCPLAB003

Change TypeReimbursement language and frequency limit added

Effective DateMay 1, 2026

Last ReviewJan 12, 2026

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request.

SourceLink

POLICY UPDATE CHANGES

Added 'or for individuals with vitamin D deficiency' and '(no more than one test every six months)' to #1, resulting in removal of statement #3.

Under Note 1, added 'chemotherapy' to letter N for clarity as a medication known to lower vitamin D levels.

References revised and literature review updates made on multiple dates.

1/6mofrequency limit added

3procedure codes referenced

≥40listed indications

multipledocument updates

Coverage Criteria for Vitamin D Testing

Primary coverage criteria

Reimbursement is conditional based on clinical indications and test type.

Covered when ALL of the following are met:

ALL of the following

ONE of the following indications (25-hydroxyvitamin D):
- Individual has an underlying disease or condition specifically associated with vitamin D deficiency or decreased bone density (see Note 1).
- Indications include, but are not limited to: biliary cirrhosis and other specified disorders of the biliary tract; celiac disease; intestinal malabsorption; inflammatory bowel disease (Crohn’s disease and ulcerative colitis); post-bariatric surgery or scheduled bariatric procedures (e.g., Roux-en-Y gastric bypass, sleeve gastrectomy); long-term use of medications known to lower vitamin D levels (anticonvulsants, glucocorticoids, chemotherapy); disorders of calcium metabolism; hyperparathyroidism or hypoparathyroidism; renal disease (Stage III-V CKD and ESRD); conditions affecting bone quality (osteomalacia, osteoporosis, osteogenesis imperfecta, rickets); and other indications listed in Note 1.
ALL of the following
- ONE of the following test-type rules:
  - 25-hydroxyvitamin D serum testing (including D2 and D3 fraction analysis as part of total 25-hydroxyvitamin D) may be reimbursable for eligible indications.
  - 1,25-dihydroxyvitamin D serum testing may be reimbursable for evaluation or treatment of conditions associated with defects in vitamin D metabolism (see Note 2).

ALL of the following

Frequency limit: No more than one 25-hydroxyvitamin D test every six months for reimbursable indications.

ALL of the following

NOT covered (do not reimburse):
- Measurement of serum 1,25-dihydroxyvitamin D to screen for vitamin D deficiency.
- Routine screening for vitamin D deficiency in asymptomatic individuals and/or during general encounters.

See Note 1 for full list of indications for 25-hydroxyvitamin D and Note 2 for indications specific to 1,25-dihydroxyvitamin D testing.

Reimbursement updates

Reimbursement Information was updated to clarify covered indications and testing frequency.

Policy changes effective 05/01/2026:

ALL of the following

Added language to Reimbursement Information #1: explicitly includes testing 'for individuals with vitamin D deficiency'.
Added a frequency limit to Reimbursement Information #1: 'no more than one test every six months'.
Note 1 updated to add 'chemotherapy' to the list of medications known to lower vitamin D levels.

These edits resulted in removal of a prior statement #3 from earlier versions; providers should refer to the current Reimbursement Information for the authoritative criteria.

Covered Indications (by condition / scenario)

Biliary cirrhosis and other disorders of the biliary tract

Covered indication for 25-hydroxyvitamin D testing.

Biliary cirrhosis and other specified disorders of the biliary tract (listed in Note 1).

Celiac disease, intestinal malabsorption, inflammatory bowel disease

Covered indication for 25-hydroxyvitamin D testing.

ALL of the following

Celiac disease, intestinal malabsorption, or inflammatory bowel disease (Crohn’s disease and ulcerative colitis) as listed in Note 1.

Post-bariatric surgery or scheduled bariatric procedures

Covered indication for 25-hydroxyvitamin D testing.

Procedure Codes and Coding Guidance

Example procedure codesCPT

82306	25-hydroxyvitamin D assay (immunoassay or other)
82652	1,25-dihydroxyvitamin D assay
0038U	Vitamin D, 25-hydroxy, quantification (likely LC-MS/MS)

Vitamin D test codingCPT

No codes listed

inv-05: 25-hydroxyvitamin D repeat interval

Repeat intervalNo more than one test every six months for reimbursable indications

Applicable test25-hydroxyvitamin D serum testing (total)

ContextApplies when individual has an underlying disease/condition associated with vitamin D deficiency, suspected hypervitaminosis D, or documented vitamin D deficiency

inv-06: testing_frequency

Maximum frequencyNo more than one test every six months

ScopeApplies to vitamin D testing as specified in Reimbursement Information #1

Testing Frequency Limits

inv-21: 25-hydroxyvitamin D

Frequency valueOne (per 6 months)

inv-22: vitamin D testing

Frequency limitNo more than one test every six months

Added indicationIncludes individuals with vitamin D deficiency (explicitly added in update)

Applies to25-hydroxyvitamin D serum testing as described in Reimbursement Information #1

Ordering and Documentation Requirements

Documentation Required

Documentation and plan-specific applicability

Providers are responsible for submission of accurate documentation of services performed and must code claims using valid, industry-standard code sets. Upon request, providers should submit any additional documentation to support medical necessity or billing.

Submit claims using valid HIPAA-approved code sets and appropriate industry coding guidelines (CPT, HCPCS, ICD-10-CM, etc.).
Be prepared to provide additional documentation upon request to support coverage or coding.

Note

Ordering requirements vary by product — review plan documents

Not all lab management reimbursement requirements apply to every product; providers should review member plan documents to determine eligible coverage for services rendered.

Check Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other plan documents for applicable coverage rules.

Definitions and References

inv-09: 25-hydroxyvitamin D

Test name25-hydroxyvitamin D (total) serum test, which may include D2 and D3 fractions as part of analysis

Typical usesAssessment for vitamin D deficiency in individuals with conditions associated with deficiency or decreased bone density

Not for routine screeningRoutine screening in asymptomatic individuals and/or during general encounters is not reimbursable

inv-10: 1,25-dihydroxyvitamin D

Test name1,25-dihydroxyvitamin D serum testing

RoleUsed for evaluation or treatment of conditions associated with defects in vitamin D metabolism (see Note 2)

Services and Tests Not Reimbursable

Measurement of serum 1,25-dihydroxyvitamin D for the purpose of screening for vitamin D deficiency is not reimbursable. The policy explicitly lists measurement of serum 1,25-dihydroxyvitamin D used to screen for deficiency as an exclusion from payment.

Routine screening for vitamin D deficiency with serum testing in asymptomatic individuals or during general encounters is not reimbursable. Testing for routine population screening without clinical indications does not meet the policy’s reimbursable criteria.

A previously present statement referenced as item #3 was removed during the 05/01/2026 update to the Reimbursement Information; the document notes the removal but the exact text of the removed exclusion is not included in the available source window.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyVitamin D Testing

Policy CodePolicy CPCPLAB003

Change TypeReimbursement language and frequency limit added

Effective DateMay 1, 2026

Last ReviewJan 12, 2026

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request.

SourceLink

On This Page

Individuals who have undergone, or who are scheduled for, bariatric procedures (e.g., Roux-en-Y gastric bypass, sleeve gastrectomy, biliopancreatic diversion) as listed in Note 1.

Long-term use of medications known to lower vitamin D levels (anticonvulsants, glucocorticoids, chemotherapy)

Covered indication for 25-hydroxyvitamin D testing related to medication effects.

Long-term use of medications known to lower vitamin D levels (examples listed in Note 1 include anticonvulsants, glucocorticoids, and chemotherapy).

Disorders of calcium metabolism, hyperparathyroidism/hypoparathyroidism

Covered indications for 1,25-dihydroxyvitamin D and 25-hydroxyvitamin D testing related to calcium disorders.

ONE of the following:

Disorders of calcium metabolism (Note 2 and Note 1 entries for hypercalcemia/hypocalcemia).
Hyperparathyroidism or hypoparathyroidism (listed in Note 1 and Note 2).

1,25-dihydroxyvitamin D testing is specifically indicated for evaluation/treatment of disorders of vitamin D metabolism (see Note 2).

Familial hypophosphatemia, Fanconi syndrome, neonatal hypocalcemia (specific to 1,25-dihydroxyvitamin D testing)

Indication specific to 1,25-dihydroxyvitamin D testing.

ONE of the following indications for 1,25-dihydroxyvitamin D testing:

Familial hypophosphatemia.
Fanconi syndrome.
Neonatal hypocalcemia.

These indications are listed in Note 2 and apply to 1,25-dihydroxyvitamin D rather than routine 25-hydroxyvitamin D screening.

Renal disease: Stage III-V CKD and ESRD

Covered indication related to renal disease.

Renal disease including Stage III-V Chronic Kidney Disease and End Stage Renal Disease (listed in Note 1 and Note 2).

Conditions affecting bone quality (osteomalacia, osteoporosis, osteogenesis imperfecta, rickets)

Covered indications affecting bone quality where vitamin D testing may be reimbursable.

ONE of the following conditions affecting bone quality:

Osteomalacia.
Osteoporosis.
Osteogenesis imperfecta.
Rickets.

These conditions are referenced across Note 1 and Note 2 depending on the specific test (25-hydroxyvitamin D versus 1,25-dihydroxyvitamin D).

Individuals with vitamin D deficiency (added to Reimbursement Information #1)

Newly added covered indication.

Individuals with documented vitamin D deficiency: 25-hydroxyvitamin D serum testing may be reimbursable (see Reimbursement Information #1).

Policy changeFrequency limit was added during document update (see Summary of Changes)

If a plan document or provider contract conflicts with this policy, the plan document or contract governs.

Note

Ordering provider restrictions not specified here

This policy does not state specific ordering-provider restrictions in the provided sections; providers should follow any additional rules in plan documents or contracts.

No explicit ordering provider restrictions are listed in this portion of the document.
Follow plan- or contract-specific ordering rules when applicable.

Billing Rule

Reimbursement edits: added deficiency indication and 6‑month frequency limit

Reimbursement information was updated to add 'individuals with vitamin D deficiency' as a covered indication and to limit reimbursable vitamin D testing to no more than one test every six months.

Policy text: Added 'or for individuals with vitamin D deficiency' to Reimbursement Information #1.
Frequency limit: '(no more than one test every six months)' was added to Reimbursement Information #1.

Screening guidanceMeasurement of serum 1,25-dihydroxyvitamin D to screen for vitamin D deficiency is not reimbursable

inv-11: References

Guideline examplesRoyal Osteoporosis Society: Vitamin D and Bone Health; USPSTF: Screening for vitamin D deficiency in adults

Clinical practice sourcesAACE/ACE clinical practice guidelines for postmenopausal osteoporosis; Mechanick et al. bariatric perioperative nutrition guidelines

Document historyReferences revised and literature reviews updated on multiple dates; Summary of Changes documents these updates