Effective 6/15/2026, Cigna’s Vitamin D Testing policy (0526) defines explicit, enumerated medical-necessity indications for total 25(OH)D (CPT 82306/0038U) and for active 1,25(OH)2D (CPT 82652), and sets repeat-testing limits. Total 25(OH)D testing is authorized only for listed conditions (e.g., rickets/osteomalacia, CKD, malabsorption, hyperparathyroidism, granulomatous disease, certain medications, extremes of age, prior deficiency, toxicity, specified genetic disorders), with repeat testing allowed only every 3 months when criteria are met. Active 1,25(OH)2D testing is limited to separate, specific indications (e.g., CKD, phosphate-wasting disorders, oncogenic osteomalacia, granulomatous or inflammatory diseases), and combined billing of both assays is expressly not covered. The policy reiterates that vitamin D testing for general population screening or unlisted indications is not covered; coverage decisions remain subject to plan language and applicable law.
June 2026 Revision: Enumerated Indications, Frequency Limits, and Combination Testing Exclusion
This revision (Effective 6/15/2026) codifies specific, enumerated medical necessity criteria for both total and active serum vitamin D testing within Cigna's coverage framework (Vitamin D Testing, Policy Number 0526). Key explicit additions/clarifications include: a defined list of diagnoses and risk states for which total serum vitamin D testing (Serum 25(OH)D, CPT 82306 or CPT 0038U) is considered medically necessary; a separate, specific list of indications for active vitamin D testing (Serum 1,25(OH)2D, CPT 82652); and defined limits on repeat testing frequency.
The policy also clarifies noncoverage rules that were restated and tightened: vitamin D testing for any other indication (including general population screening) is not covered or reimbursable; repeat total vitamin D testing (CPT 82306) is medically necessary only at intervals of every 3 months when criteria are met; testing more frequently or for other conditions is not covered. Additionally, the policy explicitly states that combined billing of both total and active vitamin D tests (CPT 82306 + CPT 82652) is not covered or reimbursable.
Medically Necessary Indications for Total Serum 25(OH)D (`CPT 82306` / `0038U`)
The policy delineates conditions that make total serum vitamin D testing (Serum 25(OH)D, CPT 82306 or CPT 0038U) medically necessary. These include classic deficiency/osseous conditions (e.g., Rickets, Osteomalacia, Osteoporosis), organ failure and malabsorption states (e.g., Chronic kidney disease, Hepatic failure, Exocrine pancreatic insufficiency, Chronic pancreatitis, and multiple Malabsorption syndromes such as cystic fibrosis and post-bariatric surgery), endocrine disorders (e.g., Hyperparathyroidism), and medication-associated risk (e.g., antiseizure medications, glucocorticoids, certain AIDS/HIV and antifungal medications).
The coverage list further includes history of nontraumatic fractures, granulomatous diseases (e.g., sarcoidosis, tuberculosis, fungal granulomatous infections), Lymphomas, specified genetic syndromes (examples: osteogenesis imperfecta, Turner syndrome, x-linked hypophosphatemia), extremes of age (age ≤ 18 years and age > 64 years), previously documented vitamin D deficiency, and known or suspected vitamin D toxicity. These conditions are enumerated as sufficient to meet medical necessity for total serum 25(OH)D testing under Cigna's standard benefit interpretation.
Indications and Separation for Active Vitamin D (`CPT 82652`) vs. Total 25(OH)D
The policy separates indications for active vitamin D testing (Serum 1,25(OH)2D, CPT 82652) from total 25(OH)D testing and lists specific clinical scenarios where 1,25(OH)2D measurement is considered medically necessary. Those included are Chronic kidney disease, hereditary or phosphate-losing disorders, Oncogenic osteomalacia, Pseudovitamin D-deficiency rickets, Vitamin D-resistant rickets, and granulomatous or inflammatory conditions (including sarcoidosis, tuberculosis, histoplasmosis, coccidiomycosis, berylliosis, lymphomas, and inflammatory bowel disease).
Importantly, the policy states that testing both CPT 82306 and CPT 82652 in combination is not covered or reimbursable, emphasizing that the two assays are intended to be applied selectively based on the clinical context outlined rather than routinely ordered together.
Repeat Testing Interval and Broad Noncoverage for Screening/Other Indications
Repeat testing parameters are specified: when initial criteria are met, repeat total vitamin D testing (CPT 82306) every 3 months is considered medically necessary. The policy explicitly disallows repeat testing more frequently than every 3 months and disallows repeat testing for conditions not listed among the covered indications.
The policy also includes a categorical noncoverage statement: vitamin D testing for any other indication, including screening in the general population, is not covered or reimbursable. The document underscores that coverage determinations depend on the member's plan language, applicable laws/regulations, and the specific facts of each case, and that services billed without covered diagnosis or procedure codes will be denied.
Professional Society Positions Cited to Support Indication-Based Coverage
The policy references multiple professional society positions to contextualize coverage criteria. It cites the Endocrine Society (2024) guidance that recommends against routine 25(OH)D testing in generally healthy adults across age groups and pregnancy, noting conditional recommendations with very low certainty. KDIGO (2017) is cited for suggesting measurement of 25(OH)D in patients with CKD stages G3a-G5D with repeat testing guided by baseline and therapy. The International Osteoporosis Foundation and the USPSTF (2021) positions are also summarized as finding insufficient evidence to support broad population screening.
Other specialty guidance is noted: AACE/ACE recommendations include measuring 25(OH)D in patients at risk for insufficiency (particularly osteoporosis) and perioperative/bariatric surgery guidelines recommending baseline and annual postoperative evaluation for certain bariatric procedures. ACOG statements reaffirm insufficient evidence for universal pregnancy screening but allow testing in those at increased risk. The American Geriatrics Society's consensus is cited, indicating routine pre-supplementation testing is unnecessary and that clinicians who monitor may test after 4 months of supplementation. These citations appear in the policy to support the selective, indication-driven approach to coverage.
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