ModifiedBlue Cross Blue Shield - OklahomaPolicy CPCPLAB003

Vitamin D Testing

Customize your policy alerts

Sign up for Blue Cross Blue Shield - Oklahoma Policy CPCPLAB003 alerts

Get alerted when Policy CPCPLAB003 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Laboratory reimbursement and coverage criteria for serum vitamin D testing (25-hydroxyvitamin D and 1,25-dihydroxyvitamin D) under Blue Cross Blue Shield of Oklahoma products; affects providers submitting claims for vitamin D laboratory services.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyVitamin D Testing

Policy CodePolicy CPCPLAB003

Change TypeReimbursement criteria updated (frequency limit addedindication language added)

Effective DateJan 12, 2026

Last ReviewJan 12, 2026

Next Review DateN/A

Key ActionSubmit documentation that supports medical necessity and limit 25-hydroxyvitamin D testing to no more than one test every six months when billing.

SourceLink

POLICY UPDATE CHANGES

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

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

Document updated with literature review; references revised.

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

ModifiedBlue Cross Blue Shield - OklahomaPolicy CPCPLAB003

Vitamin D Testing

Customize your policy alerts

Sign up for Blue Cross Blue Shield - Oklahoma Policy CPCPLAB003 alerts

Get alerted when Policy CPCPLAB003 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyVitamin D Testing

Policy CodePolicy CPCPLAB003

Change TypeReimbursement criteria updated (frequency limit addedindication language added)

Effective DateJan 12, 2026

Last ReviewJan 12, 2026

Next Review DateN/A

Key ActionSubmit documentation that supports medical necessity and limit 25-hydroxyvitamin D testing to no more than one test every six months when billing.

SourceLink

POLICY UPDATE CHANGES

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

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

Document updated with literature review; references revised.

1 per 6 monthsfrequency limit

82306,82652,0038Uprocedure codes

25-OH & 1,25(OH)2tests covered

≥35 listednamed indications

chemotherapymedication noted

Coverage Criteria for Vitamin D Testing

inv-01: 25-hydroxyvitamin D - Medically Necessary Indications

Covered when ANY of the following indications apply (25-hydroxyvitamin D):

Indications for 25-hydroxyvitamin D: Testing is reimbursable for individuals with an underlying disease or condition which is specifically associated with vitamin D deficiency or decreased bone density; for individuals suspected of hypervitaminosis D; or for individuals with vitamin D deficiency.no more than one test every six months

Specific eligible indications are enumerated in Note 1 (see list).

inv-02: 1,25-dihydroxyvitamin D - Medically Necessary Indications

Covered when ANY of the following indications apply (1,25-dihydroxyvitamin D):

Indications for 1,25-dihydroxyvitamin D: Testing is reimbursable for evaluation or treatment of conditions that are associated with defects in vitamin D metabolism.none specified

Specific eligible indications are listed in Note 2 (see list).

inv-03: Not Reimbursable / Not Medically Necessary

Not reimbursable uses: Measurement of serum 1,25-dihydroxyvitamin D to screen for vitamin D deficiency; routine screening for vitamin D deficiency with serum testing in asymptomatic individuals and/or during general encounters.

These uses are explicitly listed as not reimbursable.

inv-04: Updated reimbursement criteria

Reimbursement Information was updated to limit testing frequency and add indication language

Reimbursement #1 update: Test coverage includes individuals with vitamin D deficiency; 25-hydroxyvitamin D testing is limited to no more than one test every six months.no more than one test every six months

Per summary of changes this update resulted in removal of prior statement #3.

Measurement of serum 1,25-dihydroxyvitamin D is intended to evaluate or manage disorders that affect vitamin D metabolism. The policy states that 1,25-dihydroxyvitamin D serum testing may be reimbursable when performed for the evaluation or treatment of conditions associated with defects in vitamin D metabolism (see Note 2). However, the policy also clarifies that measurement of serum 1,25-dihydroxyvitamin D specifically to screen for vitamin D deficiency is listed as not reimbursable and may be denied.

The document notes an operational change to reimbursement information: a prior numbered statement (#3) was removed when language was added to #1 and a frequency limit was applied. The policy summary indicates that the removal of statement #3 resulted from adding "or for individuals with vitamin D deficiency" and the frequency limit "(no more than one test every six months)" to reimbursement item #1.

Routine population screening for vitamin D deficiency is not supported. The policy explicitly lists routine screening for vitamin D deficiency with serum testing in asymptomatic individuals as not reimbursable. Providers should order 25-hydroxyvitamin D testing only for covered indications described elsewhere in the policy (for example, underlying diseases associated with deficiency, suspected hypervitaminosis D, or documented deficiency).

Content not explicitly stated in this segment; see the Reimbursement Information summary of changes for related operational updates.

Specific Covered Indications

inv-23: Conditions associated with vitamin D deficiency or decreased bone density (see Note 1 list)

Conditions associated with vitamin D deficiency or decreased bone density (see Note 1 list):

Note 1 conditions: A. Biliary cirrhosis and other specified disorders of the biliary tract

Note 1 conditions: B. Blind loop syndrome

Note 1 conditions: C. Celiac disease

Note 1 conditions: D. Coronary artery disease where risk of progression is considered against benefits of chronic vitamin D and calcium therapy

Procedure Codes and Coding Details

Procedure Codes referencedCPT

82306	Vitamin D; 25-hydroxy
82652	Vitamin D; 1,25-dihydroxy
0038U	Mass spectrometry method for 25-hydroxyvitamin D measurement (as listed)

Procedure Codes referenced (duplicate listing)CPT

82306	Vitamin D; 25-hydroxy
82652	Vitamin D; 1,25-dihydroxy
0038U	Mass spectrometry method for 25-hydroxyvitamin D measurement (as listed)

25-hydroxyvitamin D testing frequency

Frequency limit25-hydroxyvitamin D serum testing reimbursable no more than one test every six months

ScopeApplies to 25-hydroxyvitamin D (serum) testing when medical indications are met (see Note 1)

Change noteFrequency limit '(no more than one test every six months)' added to Reimbursement #1 (01/12/2026)

Testing Frequency Limits

25-hydroxyvitamin D serum testing — no more than one.

Frequency limit25-hydroxyvitamin D serum testing: no more than one test every six months.

Covered indicationsIndividuals with an underlying disease/condition associated with vitamin D deficiency or decreased bone density; individuals suspected of hypervitaminosis D; individuals with documented vitamin D deficiency.

D2/D3 fraction testingAs part of total 25-hydroxyvitamin D analysis, testing for D2 and D3 fractions may be reimbursable.

Documentation to support testingClinical documentation should reflect the covered indication (disease/deficiency/hypervitaminosis) and support testing frequency consistent with the policy (no more than one test every six months).

Plan-specific reimbursement criteriaReimbursement is subject to Plan lab management reimbursement criteria; providers should review product-specific plan documents for eligibility and requirements.

Provider Actions and Billing Requirements

Prior Authorization

Follow plan-specific lab reimbursement criteria

Reimbursement is governed by Plan lab management reimbursement criteria and not all requirements apply to every product; providers should review the member's specific plan documents for product-specific eligibility before ordering or submitting claims.

Note

Prior authorization — not specified

Prior authorization requirements are not specified in this document segment; verify product-specific plan documents for any prior authorization obligations.

Note

Provider action — see plan documents

No specific provider action is defined in this segment for this inventory item; consult the full plan documents and provider contract for any applicable responsibilities.

Ordering and Authorization Requirements

Billing Rule

Verify plan coverage and submit valid claims

Providers should verify product-specific plan documents for eligible coverage and are responsible for submitting claims with valid code combinations and supporting documentation.

Confirm member eligibility and product-specific coverage before ordering.
Use the appropriate CPT codes (e.g., 82306, 82652, 0038U where applicable) and supporting documentation.

Note

Ordering authority — not specified

This document segment does not specify who may order vitamin D testing; consult the applicable plan documents or provider contract for any ordering restrictions.

Services Not Covered

The policy identifies that routine screening of asymptomatic individuals is not covered. It further specifies that using 1,25-dihydroxyvitamin D measurements to screen for vitamin D deficiency is not reimbursable and claims may be denied when used for screening purposes.

This document segment does not list additional specific tests or indications that are explicitly excluded beyond the routine screening and use of 1,25-dihydroxyvitamin D for screening; the summary of changes references removal of a prior statement but does not provide further exclusion details in this segment.

Background

25-hydroxyvitamin D testing is used to assess vitamin D status and is reimbursable for individuals with conditions associated with deficiency or decreased bone density, for those suspected of hypervitaminosis D, or for individuals with documented vitamin D deficiency. The policy emphasizes that routine population screening is not supported and that testing frequency is limited under the reimbursement rules.

Definitions

25-hydroxyvitamin D - primary analyte & reimbursement note

Definition25-hydroxyvitamin D is the primary serum analyte used to assess vitamin D status

Reimbursement noteAs part of total 25-hydroxyvitamin D analysis, testing for D2 and D3 fractions may be reimbursable

FrequencyReimbursable up to once every six months when medical indications are met

1,25-dihydroxyvitamin D - active metabolite & uses

Definition1,25-dihydroxyvitamin D is the active metabolite of vitamin D used to evaluate defects in vitamin D metabolism

Clinical usesReimbursable for evaluation or treatment of conditions associated with defects in vitamin D metabolism (see Note 2 list: e.g., disorders of calcium metabolism, familial hypophosphatemia, Fanconi syndrome, hyperparathyroidism, CKD stage III-V/ESRD, sarcoidosis)

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyVitamin D Testing

Policy CodePolicy CPCPLAB003

Change TypeReimbursement criteria updated (frequency limit addedindication language added)

Effective DateJan 12, 2026

Last ReviewJan 12, 2026

Next Review DateN/A

Key ActionSubmit documentation that supports medical necessity and limit 25-hydroxyvitamin D testing to no more than one test every six months when billing.

SourceLink

On This Page

Note 1 conditions: E. Dermatomyositis

Note 1 conditions: F. Eating disorders

Note 1 conditions: G. Prior or scheduled bariatric procedures (Roux-en-Y gastric bypass, sleeve gastrectomy, biliopancreatic diversion with/without duodenal switch)

Note 1 conditions: H. Hypercalcemia, hypocalcemia, or other disorders of calcium metabolism

Note 1 conditions: I. Hyperparathyroidism or hypoparathyroidism

Note 1 conditions: J. Individuals receiving hyperalimentation

Note 1 conditions: K. Inflammatory bowel disease (Crohn's disease and ulcerative colitis)

Note 1 conditions: L. Intestinal malabsorption

Note 1 conditions: M. Liver cirrhosis

Note 1 conditions: N. Long term use of anticonvulsants, glucocorticoids, chemotherapy, and other medications known to lower vitamin D levels

Note 1 conditions: O. Malnutrition

Note 1 conditions: P. Myalgia and other myositis not specified

Note 1 conditions: Q. Myopathy related to endocrine diseases

Note 1 conditions: R. Neoplastic hematologic disorders

Note 1 conditions: S. Osteogenesis imperfecta

Note 1 conditions: T. Osteomalacia

Note 1 conditions: U. Osteopetrosis

Note 1 conditions: V. Osteoporosis

Note 1 conditions: W. Pancreatic steatorrhea

Note 1 conditions: X. Primary or miliary tuberculosis

Note 1 conditions: Y. Psoriasis

Note 1 conditions: Z. Regional enteritis

Note 1 conditions: AA. Renal, ureteral, or urinary calculus

Note 1 conditions: BB. Rickets

Note 1 conditions: CC. Sarcoidosis

Note 1 conditions: DD. Stage III-V Chronic Kidney Disease and End Stage Renal Disease

Note 1 conditions: EE. Systemic lupus erythematosus

inv-24: Conditions associated with defects in vitamin D metabolism (see Note 2 list)

Conditions associated with defects in vitamin D metabolism (see Note 2 list):

Note 2 conditions: A. Disorders of calcium metabolism

Note 2 conditions: B. Familial hypophosphatemia

Note 2 conditions: C. Fanconi syndrome

Note 2 conditions: D. Hyperparathyroidism or hypoparathyroidism

Note 2 conditions: E. Individuals receiving hyperalimentation

Note 2 conditions: F. Neonatal hypocalcemia

Note 2 conditions: G. Osteogenesis imperfecta

Note 2 conditions: H. Osteomalacia

Note 2 conditions: I. Osteopetrosis

Note 2 conditions: J. Primary or miliary tuberculosis

Note 2 conditions: K. Renal, ureteral, or urinary calculus

Note 2 conditions: L. Rickets

Note 2 conditions: M. Sarcoidosis

Note 2 conditions: N. Stage III-V Chronic Kidney Disease and End Stage Renal Disease

inv-26: individuals with vitamin D deficiency

Individuals with vitamin D deficiency: Language was explicitly added to reimbursement information to include testing for individuals with vitamin D deficiency; testing limited to no more than one test every six months.

vitamin D level testing (25-hydroxyvitamin D) — no more than one test.

Frequency limitVitamin D level testing (25-hydroxyvitamin D): no more than one test every six months.

Scope of testingIncludes testing for D2 and D3 fractions as part of total 25-hydroxyvitamin D analysis when reimbursable.

Not reimbursable usesMeasurement of serum 1,25-dihydroxyvitamin D to screen for deficiency and routine screening of asymptomatic individuals are not reimbursable.

Provider action - documentationSubmit accurate clinical documentation that supports the medical necessity and testing frequency (indication and timing) when filing claims.

Provider action - plan reviewVerify product-specific plan documents; reimbursement is governed by Plan lab management reimbursement criteria and may vary by product.

Prior Authorization

Frequency limit and plan-specific reimbursement/documentation requirements

Requests for more than one serum vitamin D (25-hydroxyvitamin D) test within a six-month period may be denied; providers should ensure testing frequency does not exceed one test every six months per the Plan's reimbursement information. Verify product-specific plan documents for coverage and submit claims with valid CPT codes and supporting clinical documentation that demonstrates a covered indication or documented vitamin D deficiency.

Frequency limit: no more than one 25-hydroxyvitamin D test every six months.
Confirm product-specific lab management reimbursement criteria; not all requirements apply to every product.
Include clinical documentation of the covered indication (e.g., conditions associated with deficiency or documented vitamin D deficiency) to support medical necessity.

Note

Provider action — see plan documents

No specific provider action is defined in this segment for this inventory item; refer to plan documents and medical policy for any applicable requirements.

Documentation Required

Submit accurate documentation and valid coding

Providers must submit accurate documentation demonstrating medical necessity and bill using valid code combinations; claims are subject to plan documents, provider contract language, medical and coding policies, and may require additional documentation upon request.

Submit claims using HIPAA-approved code sets and industry-standard coding guidelines.
Provide additional documentation if requested during claim review.

Documentation Required

Document clinical indication and testing interval

Clinical records should document the covered indication (e.g., conditions associated with vitamin D deficiency or defects in vitamin D metabolism) and support testing frequency consistent with the policy (no more than one test every six months).

Document the specific clinical indication from Note 1 or Note 2 as applicable.
Record dates of prior 25-hydroxyvitamin D testing to demonstrate compliance with the six-month frequency limit.

Denial Risk

Denial risk — routine screening and inappropriate 1,25-dihydroxyvitamin D use

Claims for vitamin D testing that represent routine screening in asymptomatic individuals or use of serum 1,25-dihydroxyvitamin D to screen for deficiency are not reimbursable and may be denied.

Avoid ordering 1,25-dihydroxyvitamin D for routine screening of vitamin D deficiency.
Ensure testing is tied to a covered clinical indication.

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

Vitamin D testing - definition

DefinitionVitamin D testing refers to laboratory measurement of serum 25-hydroxyvitamin D to assess vitamin D status

Tests addressedPolicy addresses both 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D testing

GuidanceRoutine screening of asymptomatic individuals is not supported; providers should follow listed clinical indications