CurrentCignaPolicy 0526

Vitamin D Testing

Defines medical necessity criteria for initial and repeat serum vitamin D testing (total 25[OH]D CPT 82306 or 0038U; active 1,25[OH]2D CPT 82652), lists covered ICD-10 diagnoses, frequency limits, exclusions, and coding guidance for Cigna-administered plans (effective 2026-06-15).

Policy Summary

PayerCigna

PolicyVitamin D Testing

Policy CodePolicy 0526

Change TypeRevised indications & frequency

Effective DateJun 15, 20269d

Next Review DateMar 15, 2027

Key ActionProviders must submit claims with covered diagnosis codes that meet the policy criteria; claims for services not accompanied by covered codes under the policy will be denied as not covered.

SourceLink

POLICY UPDATE CHANGES

Revised policy statement indications and frequency of testing (annual review).

Revised policy statement on frequency of testing (annual review).

Revised frequency policy statement (focused review).

Focused reviews with no clinical policy statement changes noted on 10/15/2025 and 8/15/2024.

Annual review with no clinical policy statement changes on 3/15/2024.

2Test types covered (25(OH)D, 1,25(OH)2D)

~60+ICD-10 codes listed (partial)

3 monthsAllowed repeat interval (25[OH]D)

Related Billing Codes

82306-VITAMIN-D-25-HYDROXY-INCLUDES-FRACTIONS-IF

CPT 82306: Laboratory Test for Vitamin D, 25 Hydroxy

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Material revisions in past 3 years

2026-06-15Policy effective date

Coverage Summary

Defines medical necessity criteria for initial and repeat serum vitamin D testing including total 25(OH)D (CPT 82306 or 0038U) and active 1,25(OH)2D (CPT 82652), lists covered ICD-10 diagnoses, frequency limits (repeat 25[OH]D allowable every 3 months when criteria are met), exclusions (combination testing and general population screening not covered), and coding guidance for Cigna-administered plans. Policy effective date: 2026-06-15. Coverage stance: covered with criteria.

Quick policy thresholds and facts

Repeat testing intervalEvery 3 months

Vitamin D toxicity referenceTotal calcium > 11.1 mg/dL; 25(OH)D typically > 150 ng/mL (375 nmol/L)

Effective date2026-06-15

Next review2027-03-15

Material changes (past 3 years)3

Medical-Necessity Criteria

Medical necessity - Total serum vitamin D (25[OH]D) testing

Total serum vitamin D testing (Serum 25(OH)D, CPT 82306 or CPT 0038U) is considered medically necessary for an individual with ANY of the following:

ANY of the following

Rickets
Osteomalacia
Osteoporosis
Chronic kidney disease
Hepatic failure

Coding

Covered CPT / HCPCS for 25(OH)DCPT|HCPCSCovered

82306	Vitamin D; 25 hydroxy, includes fraction(s), if performed.
0038U	Vitamin D, 25 hydroxy D2 and D3, by LC-MS/MS, serum microsample, quantitative.

Covered CPT for 1,25(OH)2DCPTCovered

82652

Vitamin D; 1,25 dihydroxy, includes fraction(s), if performed.

Considered medically necessary ICD-10-CM diagnoses (partial list)ICD-10Covered

A15.0-A19.9	Tuberculosis (various)
B38.0-B38.9	Coccidioidomycosis
B39.0-B39.9	Histoplasmosis
C22.0-C22.9	Malignant neoplasm of liver and intrahepatic bile ducts
C23	Malignant neoplasm of gallbladder
C24.0-C24.9	Malignant neoplasm of other and unspecified parts of biliary tract
C25.0-C25.9	Malignant neoplasm of pancreas
C81.00-C81.9A	Hodgkin lymphoma
C82.00-C82.9A	Follicular lymphoma
C83.00-C83.9A	Non-follicular lymphoma

1–10 of 65

1/7

Not covered / Not reimbursable ICD-10-CMICD-10Not Covered

All other codes

All other diagnosis codes not specifically listed as considered medically necessary

Provider Actions & Operational Rules

Prior Authorization

Medical necessity documentation required for vitamin D testing

Providers must submit claims with covered diagnosis codes that meet the policy criteria; claims for services not accompanied by covered codes under the policy will be denied as not covered.

82306
0038U
82652

Billing Rule

Frequency limitation for repeat 25(OH)D testing

Repeat 25(OH)D testing (CPT 82306) is medically necessary every 3 months when policy criteria are met. Claims for repeat testing more frequently than every 3 months will be denied.

82306 — Deny if performed more frequently than every 3 months

Background & Evidence

Vitamin D exists as circulating 25-hydroxyvitamin D (25[OH]D), produced in the liver and representing the major, more stable circulating form, and the hormonally active 1,25-dihydroxyvitamin D (1,25[OH]2D), produced in the kidney and present at much lower concentrations with a short half-life. 25(OH)D is the preferred laboratory indicator to diagnose vitamin D deficiency and to assess vitamin D status because it better reflects total vitamin D exposure and has a much longer half-life than 1,25(OH)2D. Assay results for 25(OH)D have shown widespread variation across methods (eg, LC-MS/MS versus nonchromatographic antibody-based assays), and interpretation can vary by reference population and geographic factors. Evidence is limited for population screening: systematic reviews and USPSTF found insufficient direct evidence to recommend routine screening of asymptomatic adults, and multiple professional society guidelines advise testing primarily in individuals with risk factors or conditions associated with deficiency.

Evidence item	Value
Time to plateau after supplementation	3-5 months (Bacon et al., 2009)
Vitamin D toxicity level	25(OH)D typically > 150 ng/mL (375 nmol/L) associated with hypercalcemia
USPSTF screening stance	Insufficient evidence to recommend screening in asymptomatic adults (2021)
Guidelines referenced	ACOG, Endocrine Society, USPSTF, KDIGO, AGA, etc. (2009-2025)

Definitions - vitamin D metabolites

Definitions:

ANY of the following

25(OH)D: Total serum 25-hydroxyvitamin D, the major circulating form used to assess vitamin D status (CPT 82306 or 0038U)
1,25(OH)2D: Active form 1,25-dihydroxyvitamin D, measured by CPT 82652; useful in specific metabolic and renal disorders

Revision History

2026-06-15material_revisionLatest

Annual review: Revised policy statement indications and frequency of testing (material change effective 6/15/2026).

2025-03-15material_revision

Annual review: Revised policy statement on frequency of testing (material change 3/15/2025).

2023-12-03material_revision

Focused review: Revised frequency policy statement (material change 12/03/2023).

Policy Summary

PayerCigna

PolicyVitamin D Testing

Policy CodePolicy 0526

Change TypeRevised indications & frequency

Effective DateJun 15, 20269d

Next Review DateMar 15, 2027

Key ActionProviders must submit claims with covered diagnosis codes that meet the policy criteria; claims for services not accompanied by covered codes under the policy will be denied as not covered.

SourceLink

On This Page

Exocrine pancreatic insufficiency

Chronic pancreatitis

Malabsorption syndromes (e.g., cystic fibrosis, inflammatory bowel disease, Crohn's disease, bariatric surgery, radiation enteritis)

Medications associated with vitamin D deficiency (e.g., antiseizure medications, glucocorticoids, AIDS/HIV medications, antifungals such as ketoconazole, cholestyramine)

History of nontraumatic fractures

Granuloma-forming disorders (e.g., sarcoidosis, tuberculosis, histoplasmosis, coccidiomycosis, berylliosis)

Genetic syndromes associated with bone/mineral disorders (e.g., osteogenesis imperfecta, idiopathic juvenile osteoporosis, Turner syndrome, X-linked hypophosphatemia, myotonic dystrophy type 2)

Previously documented vitamin D deficiency

Known or suspected excessive vitamin D blood levels (i.e., toxicity)

Medical necessity - Active serum vitamin D (1,25[OH]2D) testing

Active serum vitamin D testing (Serum 1,25(OH)2D, CPT 82652) is considered medically necessary for an individual with ANY of the following:

ANY of the following

Chronic kidney disease
Hereditary phosphate-losing disorders
Oncogenic osteomalacia
Pseudovitamin D-deficiency rickets
Vitamin D-resistant rickets
Granuloma-forming disorders (e.g., sarcoidosis, tuberculosis, histoplasmosis, coccidiomycosis, berylliosis, lymphomas, inflammatory bowel disease)

Repeat testing frequency

Repeat testing when the above criteria are met:

ALL of the following

Repeat vitamin D testing (CPT 82306) every 3 months is medically necessary
Every 3 months = allowable interval
Repeat vitamin D testing more frequently than every 3 months and for conditions other than those listed is not covered or reimbursable
Deny more frequent testing or testing for non-listed conditions

Combination testing exclusion

Combination testing is not covered:

ALL of the following

Vitamin D testing utilizing both CPT 82306 and CPT 82652 in combination is not covered or reimbursable

Not covered

Not covered indications:

ALL of the following

Screening in the general population (asymptomatic individuals without the listed conditions) is not covered or reimbursable

Revision history implications for coverage criteria

Revision history implications for coverage criteria:

ALL of the following

Updates to CPT, HCPCS, or ICD-10 code sets may affect which submitted codes are eligible for reimbursement; deleted or inactive codes at the time of service may not be reimbursable
When policy criteria reference conditions or age thresholds, changes in clinical evidence or coding updates reflected in future policy revisions may alter coverage determinations going forward; coverage is determined by the policy version effective on the date of service
Providers must submit the most appropriate and current codes in effect on the date of service; claims using codes not listed or rendered inactive may be denied
Medical directors retain discretion to exercise clinical judgment for individual cases; revisions to the policy may include additions, removals, or clarifications of covered indications and testing intervals

Billing Rule

Combination test exclusion

Do not bill CPT 82306 and CPT 82652 in combination; testing utilizing both codes together is not covered or reimbursable.

82306
82652

Documentation Required

Use most appropriate codes and plan terms

When billing, providers must use the most appropriate codes valid on the date of service and consider the member's specific benefit plan document since plan terms may supersede this policy.

Documentation Required

Adhere to revised indications and frequency

Providers must follow the updated policy indications and testing frequency effective 6/15/2026 and document the clinical rationale in the medical record when ordering vitamin D testing.

Policy effective date: 2026-06-15

Prior Authorization

Policy changes may affect prior authorization

Policy changes to indications and frequency may alter prior authorization requirements or coverage decisions; check plan-specific prior authorization tools and operational rules for any changes effective 6/15/2026.

Check plan-specific prior authorization tools

2025-10-15administrative_review

Focused review: No clinical policy statement changes (administrative/clarified 10/15/2025).

2024-08-15administrative_review

Focused review: No clinical policy statement changes (administrative/clarified 8/15/2024).

2024-03-15administrative_review

Annual review: No clinical policy statement changes (administrative/clarified 3/15/2024).