Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerPolicy UpdatesLaboratory/Pathologyeocco Vitamin D Testing Coverage Update | OpenPaye…
    Ask Trek AI about this page
    CurrenteoccoPolicy N/A

    Vitamin D Testing

    Customize your policy alerts

    Sign up for all eocco policy alerts

    Know when eocco releases new policies or updates existing guidance.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Policy governing medical necessity and coverage of serum vitamin D tests (25-hydroxyvitamin D and 1,25-dihydroxyvitamin D) for members; applies to providers submitting claims to the payer.

    Policy Summary
    Payereocco
    PolicyVitamin D Testing
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateJun 1, 2026
    Last ReviewMay 27, 2026
    Next Review DateMay 27, 2026
    Key ActionInclude an applicable diagnosis code from Appendix 1 on the claim when ordering vitamin D testing.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    2Vitamin D analytes named
    1LCMS/MS code listed
    multipleAppendix 1 diagnosis codes
    Appendix 2Medicare guidance referenced

    Coverage Criteria for Vitamin D Testing

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    inv-01: Medically Necessary Indications

    Covered when ALL of the following are met:

    Main criteria: 1) Serum 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] testing may be considered medically necessary when the patient has a clinically documented underlying disease or condition which is specifically associated with vitamin D deficiency, decreased bone density, or defects in vitamin D metabolism as listed in Appendix 1; 2) Diagnosis information is submitted on the claim to demonstrate that testing meets criteria.

    Appendix 1 lists applicable diagnosis codes (see Appendix 1).

    inv-02: Not Medically Necessary — single top-level node

    Not medically necessary: 25(OH)D and 1,25(OH)2D serum testing are not considered medically necessary unless there is clinical documentation of an underlying disease or condition specifically associated with vitamin D deficiency, decreased bone density, or defects in vitamin D metabolism as listed in Appendix 1.

    Routine population-based screening is not recommended.

    Routine population-based screening or testing of asymptomatic individuals for vitamin D is not supported by the evidence and is excluded from coverage. Testing should be limited to situations where there is a documented clinical condition specifically associated with vitamin D deficiency, decreased bone density, or defects in vitamin D metabolism (see Appendix 1 for examples and codes). The policy notes that clinical studies do not demonstrate benefit from routine screening and that major guideline bodies do not recommend universal population screening; therefore vitamin D testing for asymptomatic population screening is not considered medically necessary.

    When Medicare National Coverage Determinations (NCDs) or Local Coverage Determinations (LCDs) apply, providers must follow those coverage rules. The policy defers to applicable CMS NCDs and LCDs (see Appendix 2 and the Medicare Coverage Database) and states that limits or exclusions established in those determinations will be followed; the health plan may consider additional indications at its discretion where NCDs/LCDs do not apply.

    In the absence of a documented condition from Appendix 1 that is specifically associated with vitamin D deficiency, decreased bone density, or defects in vitamin D metabolism, serum testing for 25(OH)D or 1,25(OH)2D is not considered medically necessary. The policy emphasizes that testing without clinical documentation linking the request to one of the covered indications lacks evidence of benefit and therefore will not be covered when those conditions are not present.

    Indications Supported by Appendix 1

    inv-23: Patients with clinically documented diseases/conditions listed in Appendix 1 that are specifically associated with vitamin D deficiency — uses Appendix 1 for extensive ICD-10 support

    Covered when the patient has a clinically documented condition from Appendix 1:

    Patients with listed conditions: Patients with clinically documented diseases or conditions listed in Appendix 1 that are specifically associated with vitamin D deficiency, decreased bone density, or defects in vitamin D metabolism (examples in Appendix 1 include sarcoidosis, chronic kidney disease, osteomalacia, osteoporosis, malabsorption disorders, and certain endocrinopathies).

    See Appendix 1 for extensive ICD-10 codes to support indications.

    inv-24: Conditions listed in Appendix 1 (osteitis deformans, urinary calculi, hypercalciuria) supporting testing

    Conditions in Appendix 1 that support testing include the following diagnosis categories:

    Applicable conditions (examples): Osteitis deformans (multiple specific M88.x and M90.x codes), urinary calculus (N20.x, N21.x, N22), and hypercalciuria (R82.994) are among the Appendix 1 diagnoses that support vitamin D testing.

    See Appendix 1 for full list of specific ICD-10 codes.

    Billing Codes and Diagnosis Lists

    Covered CPT/HCPCS CodesCPTCovered
    0038UVitamin D, 25 hydroxy D2 and D3, by LCMS/MS, serum microsample, quantitative.
    82306Vitamin D, 25 hydroxy, includes fraction(s), if performed.
    82652Vitamin D, 1,25 dihydroxy, includes fraction(s), if performed.
    Not Covered CPT or HCPCS CodesCPTNot Covered
    No codes listed
    Applicable Diagnosis Codes (Appendix 1) — sample entriesICD-10
    A15.0 - A19.9Tuberculosis.
    A28.1Cat scratch disease.
    B20Human immunodeficiency virus [HIV] disease.
    D86.0 - D86.9Sarcoidosis.
    E55.0 - E55.9Vitamin D deficiency.
    M80.00 - M81.8Osteoporosis.
    M83.0 - M83.9Adult osteomalacia.
    N18.1 - N18.9Chronic kidney disease (CKD).
    Z68.35 - Z68.45BMI 35.0 or greater, adult [bariatric surgery].
    Applicable Diagnosis Codes (Appendix 1)ICD-10Covered
    M88.851Osteitis deformans of right thigh.
    M88.852Osteitis deformans of left thigh.
    M88.859Osteitis deformans of unspecified thigh
    M88.861Osteitis deformans of right lower leg.
    M88.862Osteitis deformans of left lower leg.
    M88.869Osteitis deformans of unspecified lower leg.
    M88.87Osteitis deformans of ankle and foot.
    M88.871Osteitis deformans of right ankle and foot.
    M88.872Osteitis deformans of left ankle and foot.
    M88.879Osteitis deformans of unspecified ankle and foot.
    1–10 of 49
    1/5
    Medicare Part B Covered Diagnosis Jurisdictionsmixed
    Jurisdiction 5Medicare Part B covered diagnosis codes applicable to Jurisdiction 5
    Jurisdiction 8Medicare Part B covered diagnosis codes applicable to Jurisdiction 8
    Miscellaneous coding
    Covered procedure codes0038U; 82306; 82652
    Code systemCPT/HCPCS (as listed in policy)
    LCMS/MS example0038U = Vitamin D, 25 hydroxy D2 and D3, by LCMS/MS, serum microsample, quantitative.
    Included test names25-hydroxyvitamin D (25[OH]D); 1,25-dihydroxyvitamin D (1,25[OH]2D)

    Provider Billing and Documentation Requirements

    Billing Rule

    Use listed CPT/HCPCS codes (0038U, 82306, 82652)

    Covered procedure codes for vitamin D testing are listed in the policy and must be used for claims: 0038U; 82306; 82652.

    • 0038U — Vitamin D, 25 hydroxy D2 and D3, by LCMS/MS, serum microsample, quantitative.
    • 82306 — Vitamin D, 25 hydroxy, includes fraction(s), if performed.
    • 82652 — Vitamin D, 1,25 dihydroxy, includes fraction(s), if performed.
    Prior Authorization

    Follow applicable Medicare NCDs/LCDs (Appendix 2)

    When Medicare NCDs or LCDs apply, providers must follow those coverage determinations per Appendix 2 and the listed jurisdictions; otherwise the plan may consider additional indications at its discretion.

    • See Appendix 2 for CMS Medicare NCD/LCD guidance and links to the Medicare Coverage Database.
    • Medicare Part B jurisdictions noted: Jurisdiction 5 and Jurisdiction 8.
    Documentation Required

    Document an Appendix 1 diagnosis when ordering

    Orderers must include an applicable diagnosis code from Appendix 1 on the order and claim to support medical necessity for vitamin D testing.

    • Document an Appendix 1 ICD-10 diagnosis code that corresponds to a condition associated with vitamin D deficiency, decreased bone density, or defects in vitamin D metabolism when ordering.
    • Examples of Appendix 1 codes include osteitis deformans codes (e.g., M88.851, M88.861) listed in Appendix 1.
    Denial Risk

    Include diagnosis on claim to avoid denial risk

    Failure to include diagnosis information on the claim may impact review and decision outcome and could result in denial.

    • Diagnosis information must be submitted on the claim to determine if the policy criteria are met.
    • Claims lacking diagnosis information to demonstrate that testing meets policy criteria may be denied.
    Documentation Required

    Submit diagnosis on the claim

    Submit the patient’s diagnosis on the claim; the policy requires diagnosis information to determine whether testing meets criteria.

    • Diagnosis information must be submitted on the claim to determine if the policy criteria are met.
    • Moda's review and decision outcome may be impacted if diagnosis information is not provided.
    Documentation Required

    Document applicable Appendix 1 diagnosis when ordering

    When ordering vitamin D testing, document an applicable diagnosis code from Appendix 1 in the patient's records and include it on the claim to support medical necessity.

    • Providers should document a relevant Appendix 1 ICD-10 code (examples include osteitis deformans series shown in Appendix 1).
    • Ensure the same diagnosis code is submitted on the claim to match the clinical documentation.
    Denial Risk

    Missing diagnosis on claim may affect review/outcome

    Claims missing the required diagnosis information may affect review and outcome; include specific Appendix 1 codes on the claim and in clinical documentation.

    • Diagnosis information must be submitted on the claim to determine if testing meets policy criteria.
    • Claims lacking diagnosis information to demonstrate that testing meets policy criteria may impact review and decision outcome and could be denied.
    Note

    CMS/NCD/LCD compliance may affect coverage

    Noncompliance with applicable CMS NCDs or LCDs may affect coverage; the health plan may cover additional indications at its discretion when NCDs/LCDs do not apply.

    • Compliance with CMS National and Local Coverage Determinations is required where applicable (see Appendix 2).
    • Where NCDs/LCDs do not apply, the plan may consider additional indications at its discretion.

    Ordering and Claim Submission

    Step Therapy

    Ordering requirement: include diagnosis information and documentation

    Claims must include diagnosis information demonstrating that testing meets policy criteria; ordering providers should document the applicable diagnosis in the medical record and on the claim.

    • Diagnosis information must be submitted on the claim to determine if the policy criteria are met.
    • Ordering providers should document clinical evidence and the specific Appendix 1 diagnosis to support medical necessity.
    Prior Authorization

    Ordering requirement: follow Medicare NCDs/LCDs where applicable

    Where Medicare NCDs/LCDs apply, providers must follow those determinations for ordering and coverage decisions; consult Appendix 2 and jurisdiction guidance.

    • Refer to the CMS Medicare Coverage Database and Appendix 2 for applicable NCDs/LCDs.
    • Medicare Part B jurisdictions noted in the policy: Jurisdiction 5 and Jurisdiction 8.

    Not Covered — When Vitamin D Testing Is Not Medically Necessary

    Population-based screening and testing of asymptomatic individuals or testing for conditions not associated with vitamin D metabolism or bone health are specifically listed as not covered. Requests for vitamin D testing that are solely for routine screening of broad populations or for indications unrelated to the disorders listed in Appendix 1 should be denied as not covered under this policy.

    Definitions and Test Analytes

    25(OH)D and 1,25(OH)2D definitions
    Primary serum test25-hydroxyvitamin D [25(OH)D] (calcidiol) — the primary serum test for vitamin D status.
    Active form note1,25-dihydroxyvitamin D [1,25(OH)2D] (calcitriol) — the active form measured in specific metabolic disorders.
    Clinical contextTesting appropriate when patient has documented disease/condition associated with vitamin D deficiency, decreased bone density, or defects in vitamin D metabolism (see Appendix 1).
    Example ICD-10 code (Appendix 1)
    ICD-10 exampleR82.994 = HYPERCALCIURIA (listed in Appendix 1).
    Use caseIncluded as a relevant diagnosis code to support medical necessity for vitamin D testing when clinically applicable.
    Appendix referenceSee Appendix 1 for full list of applicable diagnosis codes supporting testing.

    Clinical Background

    Vitamin D plays an essential role in calcium absorption, bone growth and remodeling, and has effects on immune and neuromuscular function. Testing of serum vitamin D (primarily 25-hydroxyvitamin D [25(OH)D], and in select metabolic disorders 1,25-dihydroxyvitamin D [1,25(OH)2D]) is appropriate when a documented disease or condition is specifically associated with vitamin D deficiency or impaired vitamin D metabolism. Examples include rickets, osteomalacia, osteoporosis, sarcoidosis, malabsorption disorders, and chronic kidney disease. The policy states that while evidence is limited for some correlations, assessment of serum levels in patients with these specific conditions is widely accepted clinical practice; by contrast, routine testing of asymptomatic populations is not supported by clinical evidence and is therefore not recommended.

    Frequency Limits

    Frequency limits
    Frequency limitsNo specific frequency limits stated in policy; frequency rules not specified.
    Claims requirementClaims must include diagnosis information demonstrating that testing meets policy criteria (ordering provider should document applicable diagnosis).
    Medicare guidanceWhere Medicare NCDs/LCDs apply, providers must follow those determinations; otherwise plan discretion applies.
    Policy Summary
    Payereocco
    PolicyVitamin D Testing
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateJun 1, 2026
    Last ReviewMay 27, 2026
    Next Review DateMay 27, 2026
    Key ActionInclude an applicable diagnosis code from Appendix 1 on the claim when ordering vitamin D testing.
    SourceLink
    On This Page
    Coverage Criteria for Vitamin D TestingIndications Supported by Appendix 1Billing Codes and Diagnosis ListsProvider Billing and Documentation RequirementsOrdering and Claim SubmissionNot Covered — When Vitamin D Testing Is Not Medically NecessaryDefinitions and Test AnalytesClinical BackgroundFrequency Limits