CurrentCignaPolicy 0526

Vitamin D Testing

Defines medical necessity criteria, repeat testing intervals, excluded indications, and associated ICD-10/CPT codes for serum vitamin D testing (25[OH]D CPT 82306 and 0038U; 1,25[OH]2D CPT 82652) for Cigna-administered health plans effective 2026-06-15. Includes background, guideline citations, and coding lists relevant to covered indications.

Policy Summary

PayerCigna

PolicyVitamin D Testing

Policy CodePolicy 0526

Change TypeRevised indications & frequency

Effective DateJun 15, 202610d

Next Review DateMar 15, 2027

Key ActionProviders must order vitamin D testing consistent with the revised policy indications and documented allowable testing frequency as updated 6/15/2026; ensure documentation supports medical necessity and frequency limits.

SourceLink

POLICY UPDATE CHANGES

Revised policy statement indications and frequency of testing (effective 6/15/2026).

Revised policy statement on frequency of testing (3/15/2025).

Revised frequency policy statement (12/03/2023 focused review).

Multiple focused reviews reported 'No clinical policy statement changes' (10/15/2025, 8/15/2024, 3/15/2024).

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

>=3 monthsMinimum repeat interval for 25(OH)D

82306+82652Combination testing excluded

Related Billing Codes

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

CPT 82306: Laboratory Test for Vitamin D, 25 Hydroxy

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

MultipleIncluded diagnostic code ranges

6Recent Review Events

Coverage Summary

Scope: Defines medical necessity criteria, repeat testing intervals, excluded indications, and associated ICD-10/CPT codes for serum vitamin D testing (25(OH)D CPT 82306 and 0038U; 1,25(OH)2D CPT 82652) for Cigna-administered health plans. Subject: Vitamin D testing (serum 25(OH)D and 1,25(OH)2D). Status: CURRENT. Effective date: 2026-06-15. Next review date: 2027-03-15. Preferred test statement: 25(OH)D is the preferred test to assess vitamin D status due to higher circulating concentration and longer half-life. Policy stance: covered_with_criteria.

Key thresholds & quick facts

Repeat testing intervalevery 3 months

Vitamin D toxicity (typical 25(OH)D level)typically > 375 nmol/L (150 ng/mL)

Vitamin D toxicity (hypercalcemia threshold)total calcium > 11.1 mg/dL

Test types covered2 (Serum 25(OH)D CPT 82306 or 0038U; Serum 1,25(OH)2D CPT 82652)

Policy effective dateEffective: 2026-06-15

Minimum repeat interval for 25(OH)D>= 3 months

Medical-Necessity Criteria

Total serum vitamin D testing (Serum 25(OH)D, CPT 82306 or 0038U) - Medically Necessary

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 / HCPCSCPT|HCPCS|mixedCovered

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
82652	Vitamin D; 1,25 dihydroxy, includes fraction(s), if performed.

Covered ICD-10 diagnoses (examples listed in policy)ICD-10Covered

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

1–10 of 71

1/8

Not covered / reimbursable (ICD-10)ICD-10Not Covered

All other codes

Any diagnosis codes not listed as covered above

Provider Actions / Billing Impact

Prior Authorization

Submit with covered diagnosis codes

Claims for vitamin D testing must be submitted with one of the covered diagnosis codes listed; services billed without a covered code under this policy will be denied as not covered.

Covered diagnosis group: ICD-10 codes listed in the policy (examples include A15.*-A19.*, D86.*, E55.*, N18.* , etc.)

Billing Rule

Frequency limit for repeat 25(OH)D

Repeat CPT 82306 is allowed every 3 months when policy criteria are met; testing more frequently is not covered and may be denied.

Affected code: 82306
Limit: every 3 months (tests more frequent than every 3 months may be denied)

Background, Evidence & Definitions

25(OH)D (serum 25-hydroxyvitamin D) is the preferred test to assess vitamin D status because it is the major circulating form, present at much higher concentration and with a much longer half-life than 1,25(OH)2D. Serum 1,25(OH)2D (the active form) is reserved for specific metabolic or renal disorders (e.g., chronic kidney disease, hereditary phosphate-losing disorders, oncogenic osteomalacia, vitamin D–resistant rickets, and certain granulomatous diseases). After initiating or changing supplementation, serum 25(OH)D levels may take 3-5 months to reach a plateau.

Evidence / Guideline	Details
Bacon time-to-plateau
Randomized trial (Bacon et al.): serum 25(OH)D levels take ~3–5 months to reach plateau after supplementation; monthly dosing plateau ~5 months (followed 9 months)
USPSTF stance (2021)
2021 USPSTF: insufficient evidence to assess benefits/harms of screening for vitamin D deficiency in asymptomatic, community-dwelling, non-pregnant adults; does not apply to hospitalized or institutionalized persons
Guideline citations summary
Multiple professional society guidelines and reviews (Endocrine Society 2024; AAP 2014; KDIGO 2017; CF Foundation 2012; AACE/AACE, ACG, ACOG, NOF/Bone Health & Osteoporosis Foundation, etc.) recommend targeted 25(OH)D testing in at-risk populations; many advise against routine population screening

25(OH)D: Serum 25-hydroxyvitamin D, the major circulating form used to diagnose vitamin D deficiency (CPT 82306 or 0038U).

1,25(OH)2D: Serum 1,25-dihydroxyvitamin D, the active form measured primarily for specific metabolic or renal disorders (CPT 82652).

Revision History

12/03/2023material

Focused review: Revised frequency policy statement.

3/15/2024non-material

Annual review: No clinical policy statement changes.

8/15/2024non-material

Focused review: No clinical policy statement changes.

Policy Summary

PayerCigna

PolicyVitamin D Testing

Policy CodePolicy 0526

Change TypeRevised indications & frequency

Effective DateJun 15, 202610d

Next Review DateMar 15, 2027

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 deficiency (e.g., antiseizure medications, glucocorticoids, AIDS/HIV medications, antifungals [e.g., ketoconazole], cholestyramine)

History of nontraumatic fractures

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

Genetic syndromes (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)

Test codes: Total serum vitamin D testing (Serum 25(OH)D, CPT 82306 or 0038U)

Active serum vitamin D testing (Serum 1,25(OH)2D, CPT 82652) - Medically Necessary

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)

Test code: Active serum vitamin D testing (Serum 1,25(OH)2D, CPT 82652)

Repeat testing

When initial criteria are met:

ALL of the following

Repeat vitamin D testing (CPT 82306) every 3 months is medically necessary
Frequency limit: every 3 months
Repeat testing more frequently than every 3 months is not covered or reimbursable
Claims for more frequent testing will be denied

When criteria above are met: repeat vitamin D testing (CPT 82306) is allowed every 3 monthsevery 3 months

Combination testing exclusions

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

Not covered

Vitamin D testing for any other indication, including screening in the general population, is not covered or reimbursable

Billing Rule

Combination testing exclusion

Do not bill CPT 82306 and CPT 82652 together for the same clinical episode — combination use is not covered or reimbursable.

Affected codes: 82306, 82652
Billing both codes for the same episode is not covered or reimbursable

Documentation Required

Clinical indication documentation

Providers should document the specific clinical indication or covered diagnosis that meets the policy criteria to support medical necessity for testing.

Documentation Required

Follow revised indications and testing frequency

Providers must order vitamin D testing consistent with the revised policy indications and documented allowable testing frequency as updated 6/15/2026; ensure documentation supports medical necessity and frequency limits.

10/15/2025non-material

Focused review: No clinical policy statement changes.

3/15/2025material

Annual review: Revised policy statement on frequency of testing.

6/15/2026materialLatest

Annual review: Revised policy statement indications and frequency of testing.

Policy Changes / Revision Summary: • Annual review 6/15/2026: Revised policy statement indications and frequency of testing. • Focused Review 10/15/2025: No clinical policy statement changes. • Annual review 3/15/2025: Revised policy statement on frequency of testing. • Focused review 8/15/2024: No clinical policy statement changes. • Annual review 3/15/2024: No clinical policy statement changes. • Focused review 12/03/2023: Revised frequency policy statement.