CurrentFidelis CarePolicy FC.PP.027

25-hydroxyvitamin D Testing in Children and Adolescents

Defines Fidelis Care reimbursement stance for 25-hydroxyvitamin D testing (CPT 82306) in children and adolescents and specifies diagnoses when testing is not covered; applies to Fidelis Care products (all except Medicare).

Policy Summary

PayerFidelis Care

Policy25-hydroxyvitamin D Testing in Children and Adolescents

Policy CodePolicy FC.PP.027

Change TypeNo material changes

Effective Date

Next Review DateSep 30, 2023

Key ActionConfirm member eligibility and submit claims; authorization does not guarantee reimbursement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

CPT 82306procedure code referenced

age 1 to <18population referenced (children and adolescents)

All except Medicareapplicability by product

ICD-10 listdiagnoses listed as not covered

09/30/2023policy review date

Coverage Exclusions and Criteria

Not covered scenarios

Coverage exclusion for testing in otherwise healthy children when billed with listed diagnosis codes.

25-hydroxyvitamin D testing (CPT 82306) is not covered for children age >= 1 and < 18 who are otherwise healthy, including those who are obese but otherwise healthy, when billed with any of the specified ICD-10 diagnosis codes.

Not covered when billed with any of the following ICD-10 codes

E66.01 — Morbid obesity due to excess calories
E66.09 — Other obesity due to excess calories
E66.1 — Drug-induced obesity

Policy Summary

PayerFidelis Care

Policy25-hydroxyvitamin D Testing in Children and Adolescents

Policy CodePolicy FC.PP.027

Change TypeNo material changes

Effective Date

Next Review DateSep 30, 2023

Key ActionConfirm member eligibility and submit claims; authorization does not guarantee reimbursement.

SourceLink

On This Page

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.

Billing, Authorization, and Provider Responsibilities

Billing Rule

Billing and Authorization Note

Please be advised that authorization does not guarantee reimbursement. To receive payment, providers must submit a claim for services rendered and should re-confirm member/enrollee eligibility at the time the service is provided. Providers should also be aware that the provider portal policy list may not be exhaustive; Fidelis Care may engage vendors whose guidelines apply to specific services, and other Fidelis Care policies or contract terms may affect payability. This section pertains to billing and correct coding and is not a statement on medical necessity.

Confirm member eligibility at the time of service
Submit a claim to receive reimbursement (authorization ≠ payment guarantee)
Authorization does not guarantee reimbursement
Provider portal policy list may be incomplete; vendor guidelines or other policies/contract terms may apply
This guidance addresses correct coding/billing, not medical necessity

Policy Definitions

Health Plan

ScopeApplies to any health plan that has formally adopted this payment policy and is operated or administered, wholly or partly, by Centene Management Company, LLC or its affiliates.

Policy status noteAdoption of this payment policy by a Health Plan does not create a contract or guarantee of payment; coverage and payment remain subject to the plan's coverage documents, applicable laws, and plan-level administrative policies and procedures.

Effective date guidanceThis payment policy is effective as of the date determined by Fidelis Care; the posting date may differ from the effective date and legal/regulatory requirements govern if there is a discrepancy.

Provider relationshipProviders referenced in the policy are independent contractors, not agents or employees of Fidelis Care; the policy does not constitute medical advice or dictate clinical practice.

E66.01	Morbid obesity due to excess calories
E66.09	Other obesity due to excess calories
E66.1	Drug-induced obesity
E66.3	Overweight
E66.8	Other obesity
E66.9	Obesity, unspecified
Z00.129	Encounter for routine child health examination without abnormal findings
Z00.8	Encounter for other general examination
Z68.52	Body mass index (BMI) pediatric, 5th percentile to less than 85th percentile for age
Z68.53	(code text unclear in source)

OpenPayer

25-hydroxyvitamin D Testing in Children and Adolescents

Coverage Exclusions and Criteria

Procedure and Diagnosis Codes

Billing, Authorization, and Provider Responsibilities

Policy Definitions