Cigna updated its vitamin D testing policy effective 6/15/2026 to clarify when total serum 25(OH)D (CPT 82306/0038U) and active 1,25(OH)2D (CPT 82652) testing are medically necessary. 25(OH)D testing is explicitly covered for cystic fibrosis as a malabsorption risk, for other high-risk diagnoses (eg, osteoporotic disease, CKD, hepatic failure, exocrine pancreatic insufficiency, granulomatous disease) and for medication-related risk factors; age ≤18 and >64 years, prior documented deficiency, and suspected toxicity are independent indications. The policy aligns specific ICD codes (including E84.0–E84.9 for cystic fibrosis) with coverage rationale and cites CF Foundation and AAP guidance recommending annual 25‑hydroxyvitamin D testing in people with CF and against using 1,25(OH)2D for routine vitamin D status assessment. Providers should order 25(OH)D testing per these criteria and note that 1,25(OH)2D is reserved for distinct, specified indications.
June 2026 Revision: Clarified Indications and Coding Alignment
Summary of changes effective 2026-06-15
This Cigna policy (0526) for vitamin D testing was updated effective 6/15/2026. The document explicitly defines circumstances in which total serum vitamin D testing (Serum 25(OH)D, CPT 82306 or CPT 0038U) is considered medically necessary and separately lists when active serum vitamin D testing (Serum 1,25(OH)2D, CPT 82652) is considered medically necessary. The update consolidates a broad list of medical diagnoses and risk groups associated with deficiency, and it includes age-based criteria (age ≤ 18 years and age > 64 years) and previously documented deficiency or suspected toxicity as indications for testing.
The revision also incorporates an enumerated set of ICD diagnosis code ranges and specific codes tied to the coverage rationale (e.g., E84.0-E84.9 for cystic fibrosis), and cites specialty guidance from the Cystic Fibrosis Foundation and the American Academy of Pediatrics to support testing indications specific to individuals with cystic fibrosis and pediatric chronic conditions.
Coverage Criteria: `25(OH)D` Testing for Cystic Fibrosis and High-Risk Diagnoses
Indications for total serum vitamin D testing (25(OH)D) in cystic fibrosis and related conditions
Cigna considers measurement of total serum vitamin D (25(OH)D, CPT 82306 or CPT 0038U) medically necessary for individuals with conditions associated with vitamin D deficiency. The policy explicitly lists cystic fibrosis under malabsorption syndromes, grouping it with conditions such as inflammatory bowel disease, Crohn's disease, bariatric surgery, and radiation enteritis.
In addition to cystic fibrosis, the policy enumerates other high-risk diagnoses (e.g., osteoporosis, chronic kidney disease, hepatic failure, exocrine pancreatic insufficiency, and granulomatous diseases) and medication-related risk (e.g., antiseizure medications, glucocorticoids, certain HIV and antifungal agents) as qualifying indications for 25(OH)D testing.
Age-Based and Prior Diagnosis Indications Including Pediatric CF
Age and prior-diagnosis based criteria relevant to testing
The policy treats age as an independent criterion: individuals aged ≤ 18 years and those aged > 64 years meet medical necessity for total serum vitamin D testing. The document also lists previously documented vitamin D deficiency and known or suspected excessive vitamin D blood levels (toxicity) as separate indications for testing.
For individuals with cystic fibrosis specifically, these age criteria intersect with CF Foundation recommendations (cited in the policy) that all people with CF have serum 25-hydroxyvitamin D measured, and that annual measurement—preferably at the end of winter—is recommended.
`1,25(OH)2D` Testing and CF/AAP Clinical Guidance
Role of active vitamin D testing (1,25(OH)2D) and specialty guidance
The policy distinguishes total serum vitamin D testing from active vitamin D testing: Serum 1,25(OH)2D (CPT 82652) is addressed separately as medically necessary for specified indications (the policy begins this section but does not list the full criteria within the excerpt provided). The Cystic Fibrosis Foundation guidance quoted in the policy specifically recommends against using serum 1,25(OH)2D to assess vitamin D status in individuals with CF, stating 25-hydroxyvitamin D is the appropriate measure.
Cigna's policy cites the CF Foundation (Tangpricha et al., 2012) which recommends annual 25-hydroxyvitamin D testing for all individuals with CF and repeat testing three months after a change in vitamin D3 dosing. The American Academy of Pediatrics guidance included in the policy similarly emphasizes using 25-OH-D for screening in children with conditions associated with reduced bone mass (including cystic fibrosis) and notes the limited value of 1,25-OH2-D for bone health assessment.
ICD Coding References Connecting Cystic Fibrosis to Coverage Criteria
Coding alignment and documented diagnostic ranges linked to cystic fibrosis
The policy text includes an extensive list of diagnosis code ranges and specific codes associated with the medical necessity rationale. Of direct relevance to cystic fibrosis, the policy cites E84.0-E84.9 as the ICD range for cystic fibrosis. Other coded conditions linked to coverage include E55.0-E55.9 (vitamin D deficiency), E67.3 (hypervitaminosis D), and multiple renal, hepatic, and metabolic disorder codes.
This coding appendix aligns the clinical indications (e.g., malabsorption syndromes including cystic fibrosis) with billable diagnosis codes to support coverage determinations for 25(OH)D testing and related services.
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