Vitamin B12 and Methylmalonic Acid Testing
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Defines reimbursement criteria for serum vitamin B12 (cobalamin) and methylmalonic acid testing under Blue Cross Blue Shield - Oklahoma lab management program; affects providers submitting claims for these laboratory tests to BCBSOK members.
Added a three month testing frequency limit: total vitamin B12 (serum cobalamin) testing may be reimbursable once every three months.
Added new #7: total vitamin B12 testing is not reimbursable for all other situations not described.
Holotranscobalamin (active B12) testing is not reimbursable for screening, testing, or confirmation of vitamin B12 deficiency.
Reimbursement Criteria for Vitamin B12 and MMA Testing
Laboratory reimbursement criteria
Covered when ALL of the following criteria (and associated limits) are met:
ANY of the following
ALL of the following
ALL of the following
- Hyperpigmentation
- Jaundice
- Vitiligo
ALL of the following
- Glossitis
ALL of the following
- Anemia (macrocytic, megaloblastic)
- Leukopenia
- Pancytopenia
- Thrombocytopenia
- Thrombocytosis
ALL of the following
- 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 (e.g., Crohn's disease, ileal resection, tapeworm infection, prior or planned bariatric procedures such as Roux-en-Y, sleeve gastrectomy, biliopancreatic diversion/duodenal switch)
- Decreased intrinsic factor (e.g., atrophic gastritis, pernicious anemia, postgastrectomy syndrome)
- Transcobalamin II deficiency
- Inadequate intake (e.g., alcohol abuse; age >75 years or elderly evaluated for dementia; vegans or strict vegetarians including exclusively breastfed infants of vegetarian/vegan mothers; eating disorders)
- Prolonged medication use (H2 blockers >12 months; metformin >4 months; proton pump inhibitors >12 months)
ANY of the following
- May be reimbursable to confirm vitamin B12 deficiency in asymptomatic high-risk individuals with low‑normal serum B12 or when deficiency is suspected but serum B12 is normal or low‑normal
- May be reimbursable for evaluation of inborn errors of metabolism
ALL of the following
- Screening for vitamin B12 deficiency in healthy, asymptomatic individuals
- Homocysteine testing for confirmation of vitamin B12 deficiency
- Holotranscobalamin (active B12) testing for screening, testing, or confirmation of vitamin B12 deficiency
- Total vitamin B12 testing for all other situations not described above
Example Codes and Frequency Limits
| 84999 | Unlisted chemistry procedure (note: policy indicates code was added in revision history but code lists are not exhaustive) |
| 84999 | Unlisted chemistry procedure (note: policy indicates code was added in revision history but code lists are not exhaustive) |
Documentation and Claims Submission Requirements
Documentation and claims submission — submit accurate documentation and valid codes; claims subject to review
Providers must submit accurate documentation of services performed and submit claims using valid code combinations according to industry-standard coding guidelines. Claims are subject to review, code edit protocols, and may require additional documentation upon request.
- Use valid code combinations per Uniform Billing Editor, AMA CPT, HCPCS, ICD-10, NDC, DRG, CMS NCCI and CCI guidance.
- Claims are subject to claim review including benefit coverage, provider contract language, medical and coding policies, and coding software logic.
- Upon request, providers may be asked to submit additional documentation.
Plan Documents and Related Terms
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