CurrentCapital BluecrossPolicy AHS G2005

Vitamin D Testing

Defines clinical indications, limitations, and monitoring frequency for serum 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D testing, assay considerations, and references to guidelines and regulations. Applies to test coverage determinations contingent on individual benefit coverage and government policy conflicts.

Policy Summary

PayerCapital Bluecross

PolicyVitamin D Testing

Policy CodePolicy AHS G2005

Change TypeRevision (04/01/2025) - no material change

Effective DateNov 16, 2015

Next Review DateN/A

Key ActionDocument the underlying disease/condition or clinical indication that meets Note 1 or Note 2 when requesting 25OHD or 1,25-dihydroxyvitamin D testing.

POLICY UPDATE CHANGES

Revision Date: 04/01/2025 (policy document header shows revision date).

2Primary analytes covered

2Monitoring frequency categories

3Guideline organizations cited

multipleEvidence references

Coverage Summary

Policy AHS G2005 (Payer: AHS) defines coverage for serum Vitamin D testing and is covered with criteria. It applies to measurement of 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D (calcitriol) with clinical indications, limitations, and monitoring frequency specified. The policy lists covered indications for 25-hydroxyvitamin D testing (including documented deficiency, conditions associated with deficiency, testing D2/D3 fractions, and suspected hypervitaminosis), frequency limits for monitoring supplementation (retesting ≥12 weeks after initiation; up to twice/year until therapeutic goal then annually), and covered indications for 1,25-dihydroxyvitamin D testing (conditions with defects in vitamin D metabolism).

Effective date: 2015-11-16; Last review / revision: 2025-04-01.

Key thresholds and monitoring guidance

Vitamin D deficiency (threshold)serum 25OHD < 20 ng/mL (deficiency); some organizations consider <30 ng/mL insufficient

Vitamin D toxicity (threshold)25OHD > 200 ng/mL (>500 nmol/L) associated with toxicity

IOM recommended rangeMaintain serum 25OHD between 20–40 ng/mL (50–100 nmol/L)

Endocrine Society preferred rangePreferred 25OHD range ~30–50 ng/mL (noted for osteoporosis/patients at risk)

Monitoring frequencyRetest at least 12 weeks after starting supplementation; then up to twice per year until therapeutic goal met, then annually thereafter

25-hydroxyvitamin D (25OHD) — Covered Indications & Monitoring

Covered Indications for 25-hydroxyvitamin D testing

25-hydroxyvitamin D serum testing MEETS COVERAGE CRITERIA when ANY of the following underlying disease/conditions or situations are present:

ANY of the following

Underlying disease/condition: Underlying disease or condition specifically associated with vitamin D deficiency or decreased bone density (see Note 1).
Suspected hypervitaminosis: Individuals suspected of hypervitaminosis of Vitamin D.
D2/D3 fractions: Testing for D2 and D3 fractions of 25-hydroxyvitamin D (total 25-hydroxyvitamin D analysis including D2 and D3).
Repeat testing after supplementation: Documented vitamin D deficiency and repeat testing at least 12 weeks after initiation of vitamin D supplementation therapy (monitoring).

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Frequency limits for monitoring 25-hydroxyvitamin D

When monitoring supplementation therapy, testing MEETS COVERAGE CRITERIA with these restrictions:

Monitoring frequency restrictions

Twice per year until goal: Twice per year testing for the monitoring of supplementation therapy, until the therapeutic goal has been achieved.
Annual once achieved: Annual testing once the therapeutic range has been achieved.
Repeat >=12 weeks after initiation: Repeat testing should be performed at least 12 weeks after initiation of supplementation.

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Note 1 - Indications for serum measurement of 25-hydroxyvitamin D (detailed list)

Testing indicated for individuals with any of the following conditions:

Note 1 indications list

Biliary disorders: Biliary cirrhosis and other specified disorders of the biliary tract
Blind loop syndrome
Celiac disease
Coronary artery disease where risk is being considered against benefits of chronic vitamin D and calcium therapy
Dermatomyositis

1,25-dihydroxyvitamin D — Covered Indications

Covered Indications for 1,25-dihydroxyvitamin D testing

1,25-dihydroxyvitamin D serum testing MEETS COVERAGE CRITERIA for evaluation or treatment of conditions associated with defects in vitamin D metabolism (see Note 2).

Defects in vitamin D metabolism: Conditions associated with defects in vitamin D metabolism (see Note 2 list: disorders of calcium metabolism; familial hypophosphatemia; Fanconi syndrome; hyperparathyroidism or hypoparathyroidism; neonatal hypocalcemia; individuals receiving hyperalimentation; osteogenesis imperfecta; osteopetrosis; osteomalacia; primary or miliary tuberculosis; rickets; renal/ureteral/urinary calculus; sarcoidosis; Stage III-V CKD and ESRD).

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Note 2 - Indications for serum testing of 1,25-dihydroxyvitamin D (detailed list)

Testing indicated for individuals with any of the following conditions:

Note 2 indications list

Disorders of calcium metabolism
Familial hypophosphatemia
Fanconi syndrome
Hyperparathyroidism/hypoparathyroidism: Hyperparathyroidism or hypoparathyroidism
Neonatal hypocalcemia

Not Covered / Exclusions

Not covered (does not meet coverage criteria)

The following uses DO NOT MEET COVERAGE CRITERIA:

Exclusions

1,25 for screening: Measurement of serum 1,25-dihydroxyvitamin D to screen for vitamin D deficiency.
Routine screening asymptomatic: Routine screening for vitamin D deficiency with serum testing in asymptomatic individuals and/or during general encounters.

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Provider Actions & Billing Rules

Documentation Required

Indication documentation required

Requests for 25OHD or 1,25-dihydroxyvitamin D testing should document the underlying disease/condition or clinical indication that meets the policy's Note 1 or Note 2 lists (e.g., malabsorption, CKD stages, bariatric surgery, suspected hypervitaminosis).

Malabsorption (e.g., celiac disease, Crohn's disease, pancreatic steatorrhea)
Chronic kidney disease (Stage III–V) and ESRD
History of or scheduled bariatric procedures (Roux-en-Y, sleeve gastrectomy, biliopancreatic diversion)
Individuals suspected of hypervitaminosis of Vitamin D

Billing Rule

Monitoring frequency constraints

When monitoring supplementation, retesting should be at least 12 weeks after initiation; testing frequency is limited to twice per year until the therapeutic goal has been achieved, then annually thereafter.

Codes affected: 82306
Required timing: repeat testing >= 12 weeks after initiation; twice/year until goal achieved, then annually

Documentation Required

Assay selection and standardization

Prefer assays standardized by the CDC VDSCP or documented standardized LC-MS/MS or HPLC assays with an appropriate measurement range; laboratories should verify that the assay meets VDSCP standardization criteria in their own environment.

CDC VDSCP (Vitamin D Standardization-Certification Program) referenced for assay standardization
Preferred analytical methods: LC-MS/MS and HPLC (LC-MS/MS considered the gold standard; can differentiate D2 and D3)
Laboratories should verify assay standardization and performance in their own hands/environments

Background & Evidence

Vitamin D exists mainly as two forms: ergocalciferol (D2) and cholecalciferol (D3); D3 is produced in skin from UV exposure and both are obtained from diet or fortified foods.

Metabolism: vitamin D is hydroxylated in the liver to form 25-hydroxyvitamin D (25OHD), the predominant and most stable circulating form used to assess status, and further hydroxylated in the kidney to the metabolically active 1,25-dihydroxyvitamin D (calcitriol) which has a much shorter half-life.

Assay variability and methods: serum 25OHD can be measured by multiple analytical methods including LC-MS/MS (LC‑MS/MS), HPLC, immunoassays (ELISA, RIA) and others; LC-MS/MS is considered the gold standard and can distinguish D2 and D3 fractions, but is used by only a minority of laboratories.

Assay standardization efforts: because of interassay variability, the CDC Vitamin D Standardization-Certification Program (VDSCP) was created to evaluate and standardize assays, provide reference measurements for 25OHD2 and 25OHD3, and recommend use of assays certified by VDSCP or standardized LC‑MS/MS/HPLC methods with appropriate measurement range and verification in each laboratory.

Evidence highlights

IOM recommendationIOM: maintain serum 25OHD between 20 and 40 ng/mL (50–100 nmol/L)

Endocrine Society preferred rangeES prefers 30–50 ng/mL for patients with osteoporosis and as a target range in some guidelines

Toxicity thresholdVitamin D toxicity reported at 25OHD >200 ng/mL (>500 nmol/L) with risks of hypercalcemia and renal injury

Evidence base notedMultiple randomized clinical trials, systematic reviews, and clinical practice guidelines (Endocrine Society, USPSTF, IOM, others) cited in support of recommendations

Definitions

25(OH)D — 25-Hydroxyvitamin D. 25OHD is the predominant and most stable circulating form used to assess vitamin D status.

1,25-dihydroxyvitamin D — Calcitriol. The metabolically active form with a short half-life; not recommended for screening for deficiency.

VDSCP — Vitamin D Standardization-Certification Program (CDC). A program to standardize vitamin D assays, provide reference measurements for 25-hydroxyvitamin D2 and D3, and certify assays that meet performance criteria.

Policy Summary

PayerCapital Bluecross

PolicyVitamin D Testing

Policy CodePolicy AHS G2005

Change TypeRevision (04/01/2025) - no material change

Effective DateNov 16, 2015

Next Review DateN/A

Key ActionDocument the underlying disease/condition or clinical indication that meets Note 1 or Note 2 when requesting 25OHD or 1,25-dihydroxyvitamin D testing.

On This Page

82306	Vitamin D; 25 hydroxy - includes fraction(s) if performed
82652	Vitamin D; 1,25 dihydroxy - includes fraction(s) if performed
0038U	Proprietary test: SensievaTm Droplet 25OH Vitamin D2/D3 Microvolume LCIMS Assay

OpenPayer

Vitamin D Testing

Coverage Summary

25-hydroxyvitamin D (25OHD) — Covered Indications & Monitoring

1,25-dihydroxyvitamin D — Covered Indications

Not Covered / Exclusions

Coding

Provider Actions & Billing Rules

Background & Evidence

Definitions

Revision History