ModifiedMolina HealthcarePolicy G2005

Vitamin D Testing

Defines clinical coverage criteria, limitations, and related guidance for serum vitamin D testing (25-hydroxyvitamin D and 1,25-dihydroxyvitamin D), including indications for initial and repeat testing, fractionated D2/D3 testing, and tests that are not covered.

Policy Summary

PayerMolina Healthcare

PolicyVitamin D Testing

Policy CodePolicy G2005

Change TypeRevised coverage criteria and notes (4/1/2025)

Effective Date

Next Review Date

Key ActionDocument indications from Note 1 or Note 2 (or suspicion of hypervitaminosis or documented deficiency with timing of supplementation) when requesting testing.

POLICY UPDATE CHANGES

Revision Date: 4/1/2025 listed in header.

Updated background, guidelines, and evidence-based scientific references; literature review necessitated changes in coverage criteria.

Removed Note 1 point S: 'S. Obesity'.

Removed 'medical necessity' language from Notes 1 and 2.

2Primary tests addressed (25OHD, 1,25-dihydroxyvitamin D)

~30Listed clinical indications in Note 1 and Note 2

3CPT/HCPCS codes referenced

1Revision entry (4/1/2025)

Coverage Summary & Scope

This policy (Policy Number: G2005) addresses coverage for serum vitamin D testing, specifically 25-hydroxyvitamin D (25[OH]D) and 1,25-dihydroxyvitamin D. Scope includes indications for initial and repeat testing, fractionated D2/D3 testing, and tests that do not meet coverage. Coverage stance is mixed — testing is covered for defined clinical indications and monitoring but is not covered for routine population screening. The policy status is MODIFIED with a revision dated 4/1/2025 that updated background, guidelines, and references and modified coverage language. Primary tests addressed are 25(OH)D and 1,25-dihydroxyvitamin D, with fractionated D2/D3 testing and a proprietary Sensieva LC-MS/MS assay referenced; retesting thresholds include a minimum interval of >= 12 weeks after initiation of supplementation.

Key thresholds & timeline

Retest interval after supplementation>= 12 weeks

Deficiency (typical)< 20 ng/mL

Insufficiency (some orgs)< 30 ng/mL

IOM recommended range20-40 ng/mL (50-100 nmol/L)

Endocrine Society preferred range (osteoporosis)30-50 ng/mL

Toxicity threshold> 200 ng/mL (>500 nmol/L)

Policy last review2025-04-01

Has material change in revisiontrue (edits to CC3; obesity note and 'medical necessity' language removed)

Indications / Clinical Notes (Note 1 & Note 2)

Operational note: the policy was revised on 4/1/2025. Edits include that CC3 was edited for clarity and consistency, Note 1 point S (Obesity) was removed, and the phrase 'medical necessity' was removed from Notes 1 and 2; update documentation, preauthorization requests, and clinician guidance accordingly.

CPT / HCPCS / Proprietary Codes

Covered / Referenced Procedure CodesmixedCovered

82306	Vitamin D; 25 hydroxy, includes fraction(s), if performed.
82652	Vitamin D; 1,25 dihydroxy, includes fraction(s), if performed.
0038U	Sensieva™ Droplet 25OH Vitamin D2/D3 Microvolume LC/MS Assay (InSource Diagnostics) - Proprietary test.

Billing guidance: report CPT 82306 for 25-hydroxyvitamin D, CPT 82652 for 1,25-dihydroxyvitamin D, and 0038U for the proprietary Sensieva Droplet LC-MS/D2-D3 microvolume assay where applicable; document the clinical indication per Notes 1 or 2 or documented deficiency and retest timing to support coverage.

Required Documentation, Billing & Denial Risks

Prior Authorization

Apply benefit coverage and government policy

Coverage determination is dependent upon the individual's benefit coverage and applicable government policies (NCDs/LCDs/state Medicaid). If conflict exists, government policy governs.

When conflicts exist, government policy (NCDs/LCDs/state Medicaid) governs.

Documentation Required

Document indication for testing

For tests to meet coverage, providers should document underlying disease/condition from Note 1 or Note 2, or suspicion of hypervitaminosis, or documented deficiency and timing of supplementation (to justify >=12 week retest).

Affected codes: 82306, 82652

Clinical Background & Evidence Summary

Background: Vitamin D is a steroid hormone precursor important for calcium absorption, bone metabolism, and regulation of parathyroid hormone and bone cells. Two major natural forms are ergocalciferol (D2) and cholecalciferol (D3); D3 is synthesized in skin after UV exposure and both forms are obtained from diet and fortified foods.

Two circulating activated forms are measured: 25-hydroxyvitamin D (25OHD), the predominant and more stable circulating form used to assess status, and 1,25-dihydroxyvitamin D (calcitriol), the metabolically active form with a much shorter half-life. Assays include immunoassays and LC-MS/MS, the latter able to differentiate D2 and D3 and considered the analytical gold standard. The CDC Vitamin D Standardization-Certification Program (VDSCP/VDSP) exists to standardize assay performance and reduce interassay variability.

Definitions commonly used: vitamin D deficiency is typically <20 ng/mL and some organizations define insufficiency as <30 ng/mL; the IOM recommends maintaining serum 25OHD between 20–40 ng/mL. Re-testing after initiating supplementation should generally wait until steady state (about three months / at least >= 12 weeks).

Endocrine Society (2024)Suggests against routine 25(OH)D testing in general adults and pregnant individuals; recommends targeted testing

IOM (2011) recommended rangeMaintain serum 25OHD 20-40 ng/mL (50-100 nmol/L)

Revision History & Material Changes

4/1/2025revisedLatest

Revision Date: 4/1/2025 listed in header; updated background, guidelines, and evidence-based scientific references; literature review necessitated changes in coverage criteria (Edited CC3 for clarity and consistency).

4/1/2025removedLatest

Removed Note 1 point S: 'S. Obesity' from indications for serum measurement of 25-hydroxyvitamin D.

4/1/2025removed

Key Definitions

25(OH)D: 25-Hydroxyvitamin D, the predominant and most stable circulating form used to assess vitamin D status.

1,25-dihydroxyvitamin D: Calcitriol, the metabolically active form with a short circulating half-life (~15 hours).

VDSCP / VDSP: CDC Vitamin D Standardization-Certification Program for assay standardization and certification to improve accuracy and comparability across methods and laboratories.

Policy Summary

PayerMolina Healthcare

PolicyVitamin D Testing

Policy CodePolicy G2005

Change TypeRevised coverage criteria and notes (4/1/2025)

Effective Date

Next Review Date

Key ActionDocument indications from Note 1 or Note 2 (or suspicion of hypervitaminosis or documented deficiency with timing of supplementation) when requesting testing.

On This Page

Billing Rule

Use appropriate CPT/HCPCS codes

Report CPT 82306 for 25-hydroxyvitamin D, 82652 for 1,25-dihydroxyvitamin D, and 0038U for the proprietary Sensieva LC/MS microvolume assay where applicable.

Codes: 82306, 82652, 0038U

Denial Risk

Risk of denial for routine screening

Claims for routine screening in asymptomatic individuals or measurement of 1,25-dihydroxyvitamin D for screening purposes may be denied as not meeting coverage criteria.

Code: 82652
Routine screening and 1,25 measurement for screening purposes may be denied.

Documentation Required

Retesting cadence documentation

When performing repeat 25OHD testing, document that retesting is at least 12 weeks after starting supplementation and frequency (twice/year until therapeutic goal reached, then annually).

Code: 82306
Retest timing: >= 12 weeks
Cadence: twice per year until therapeutic goal achieved, then annually

Note

Policy changes require clinician awareness

Providers should note that CC3 language was edited and that Note 1 point S (Obesity) and 'medical necessity' language in Notes 1 and 2 were removed; update documentation and preauthorization requests accordingly.

Removed items: Note 1 point S (Obesity) and 'medical necessity' language in Notes 1 and 2
Advise updating documentation and preauthorization requests to reflect these changes

Retest timing (NHS)Re-testing before 3 months not advised; steady state ~3 months after loading/maintenance

CDC VDSCPVitamin D Standardization-Certification Program for assay standardization (references 2017-2019, cited 2019/2024)

USPSTF (2021)Insufficient evidence to assess balance of benefits/harms of screening in asymptomatic adults (I statement)

AACE / AACE guidance (2020)Recommend measuring 25(OH)D in patients at risk, maintain >=30 ng/mL in osteoporosis (preferable 30-50 ng/mL)

Royal Osteoporosis Society (ROS)Defines thresholds in nmol/L: <25 nmol/L deficient; 25-50 nmol/L may be inadequate; >50 nmol/L sufficient

Removed 'medical necessity' language from Notes 1 and 2 (operational language change in notes).

editedLatest

CC3 edited for clarity and consistency as part of revisions to coverage criteria.