UnitedHealthcare Vitamin D Testing Coverage Update

Coverage Criteria — Medical Necessity

Medical necessity for vitamin D testing

Covered when ALL of the following are met

Medicare and general coverage conditions: Test is ordered for a condition or medical diagnosis associated with vitamin D deficiency or risk of hypercalcemia (not routine population screening).

Refer to Vitamin D Testing: Diagnosis Codes list and applicable LCD/LCA for contractor-specific requirements.

Guideline-based testing scenarios

Coverage considerations reflect multiple guideline positions:

Testing not routinely required before supplementation for older adults: American Geriatrics Society: laboratory testing for serum 25(OH)D is not necessary before supplementation and repeated testing is not needed; goal is >=30 ng/mL for older adults.30 ng/mL

AGS consensus statement

Testing appropriate when clinical risk or symptoms present: Endocrine Society, NICE, and ASCP recommend testing primarily for individuals at risk for deficiency or with clinical signs (e.g., osteomalacia) rather than routine population screening.

Targeted screening

Asymptomatic adults screening stance: USPSTF concluded evidence is insufficient to assess benefits and harms of screening asymptomatic adults; routine screening not supported by strong evidence.

USPSTF 2021

CKD-specific guidance: National Kidney Foundation (KDOQI) recommends vitamin D supplementation for deficiency/insufficiency in adults with CKD stages 1-5D and posttransplantation and provides guidance on calcium intake adjustments in CKD.

KDOQI 2020

Pre- and post-bariatric surgery: ASMBS recommends nutrient screening for vitamin D and calcium pre- and post-weight loss surgery; evidence is insufficient to recommend routine vitamin D binding protein assays.

ASMBS 2017

For Medicare members, vitamin D testing may not be used for routine screening; testing is covered only when it is reasonable and necessary for a specific condition or medical diagnosis associated with vitamin D deficiency or risk of hypercalcemia. Providers should refer to the policy's Applicable Diagnosis Codes list and any applicable LCD/LCA for contractor-specific requirements when determining medical necessity.

Multiple clinical organizations advise against routine population-wide vitamin D screening in asymptomatic adults. The USPSTF concluded the evidence is insufficient to assess benefits and harms of screening asymptomatic adults, and the American Geriatrics Society states that laboratory testing is not necessary before supplementation in older adults.

Population-based routine screening for vitamin D deficiency has limited supporting evidence and may be low value. Health system interventions, such as targeted electronic health record alerts and clinician education, have been shown to reduce unnecessary testing and can help align ordering with risk-based guidance.

Many individuals do not require vitamin D testing because testing often does not change treatment for the individual; modest dietary changes are frequently sufficient to correct mild insufficiency in otherwise healthy people.

Covered Indications and At-risk Populations

Condition or medical diagnosis associated with vitamin D deficiency or risk of hypercalcemia

Covered diagnosis guidance: Condition or medical diagnosis associated with vitamin D deficiency or risk of hypercalcemia.

Refer to the policy's Diagnosis Codes list and applicable LCD/LCA for specifics.

Assessment of vitamin D status for individuals at risk

Assessment indicated for at-risk individuals: Assessment of vitamin D status is appropriate for individuals at increased risk or with clinical indications, including pre- and post-bariatric surgery patients, adults with chronic kidney disease (CKD) including those receiving dialysis or posttransplantation, and symptomatic individuals or those with conditions suggestive of deficiency (e.g., osteomalacia, clinical signs of deficiency).

Follow guideline-specific recommendations (ASMBS for bariatric patients; KDOQI for CKD; Endocrine Society for at-risk individuals).

Not Covered — Screening and Population Testing

Not covered: routine screening of asymptomatic populations or indiscriminate population‑based testing. Under Medicare statute, screening tests are governed by law and vitamin D testing must be reasonable and necessary for a specific condition or diagnosis; testing performed solely for screening purposes is not supported.

Not covered: routine vitamin D screening in asymptomatic individuals without risk factors. Several organizations, including the USPSTF, do not support population‑level routine testing in asymptomatic adults because evidence is insufficient to demonstrate net benefit.

Coding — Procedure and Diagnosis Codes

Applicable CPT Codes (listed)CPT

82652

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

Removed Diagnosis CodesICD-10

E20.8	removed from Applicable Diagnosis Codes
K91.1	removed from Applicable Diagnosis Codes
K91.81	removed from Applicable Diagnosis Codes
M85.811	removed from Applicable Diagnosis Codes
M85.812	removed from Applicable Diagnosis Codes
M85.821	removed from Applicable Diagnosis Codes
M85.822	removed from Applicable Diagnosis Codes
M85.831	removed from Applicable Diagnosis Codes
M85.832	removed from Applicable Diagnosis Codes
M85.841	removed from Applicable Diagnosis Codes

1–10 of 18

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inv-09: AGS 25(OH)D target — 30 ng/mL (75 nmol/L)

AGS 25(OH)D target30 ng/mL (75 nmol/L)

Purpose of targetMinimum goal for older adults to reduce falls and fall-related injuries

Guidance on testing before supplementationAGS states laboratory testing for serum 25(OH)D is not necessary before supplementation

inv-10: AGS minimum serum 25(OH)D — 30 ng/mL (75 nmol/L)

AGS minimum serum 25(OH)D30 ng/mL (75 nmol/L)

Population addressedOlder adults (primary care practitioners caring for aging population)

Provider Actions, Documentation, and Billing

Note

Coverage & contractor guidance for CPT 82652

Coverage for CPT 82652 (Vitamin D; 1,25-dihydroxy) is determined by the member-specific benefit plan and applicable laws. CPT 82652 is listed here for reference; its inclusion does not guarantee coverage or payment. Where Medicare Local Coverage Determinations (LCDs) or Local Coverage Articles (LCAs) apply, providers must follow those contractor-specific requirements.

CPT 82652 — Vitamin D; 1,25-dihydroxy (listed for reference)

Prior Authorization

Delegate-managed prior authorization

Delegate organizations managing UnitedHealthcare Medicare Advantage plans may have their own prior authorization or utilization review requirements. Providers should check the delegate’s published administrative requirements and obtain any required prior authorization before rendering services to Medicare Advantage members.

Delegate-managed prior authorization may apply for Medicare Advantage members

Ordering Requirements and Prior Authorization

Step Therapy

Orderers must follow LCD/LCA guidance and document indication

Follow contractor LCD/LCA ordering requirements and include the clinical indication on orders; verify member-specific benefits to determine whether testing is covered.

If no local LCD/LCA is found, apply the coverage rationale in this policy.
Refer to the Vitamin D Testing: Diagnosis Codes list for acceptable indications.

Billing Rule

Verify benefits, follow delegate PA, and submit accurate claims

Verify member-specific benefit plan coverage and any applicable delegate prior authorization requirements before ordering; submit accurate claims and maintain supporting documentation.

Benefit coverage is determined by the member-specific benefit plan document; contact customer service or refer to the Administrative Guide for member coverage questions.

Frequency Limits and Follow-up Testing

inv-25: FREQUENCY LIMITS — (unnamed key_value inventory item)

General frequency ruleNo routine repeated testing recommended after supplementation for older adults

Test referencedSerum 25(OH)D concentration

Clinical contextAGS indicates clinical management with repeated lab tests is not needed

inv-26: serum 25(OH)D — No routine repeated testing recommended after supplementation in older adults

RecommendationNo routine repeated testing recommended for clinical management after supplementation in older adults

TestSerum 25(OH)D

Background — Clinical Context

Vitamin D deficiency results from inadequate intake, impaired absorption or activation, limited sunlight exposure, or conditions that alter vitamin D metabolism. Testing is intended to evaluate suspected deficiency or conditions associated with altered vitamin D metabolism (including risk of hypercalcemia). Guideline statements vary: the American Geriatrics Society recommends a serum 25(OH)D target of 30 ng/mL (75 nmol/L) for older adults and indicates testing is not required before supplementation, while other societies focus testing on patients with clinical risk factors or symptoms.

Definitions and Clinical Targets

inv-20: Vitamin D deficiency — definition and common causes

DefinitionVitamin D deficiency results from dietary inadequacy, impaired absorption or use, increased requirement, increased excretion, limited sunlight exposure, or impaired renal activation

Common cause — intakeUsual intake lower than recommended levels over time

Common cause — sunlightLimited exposure to sunlight reduces vitamin D synthesis

Common cause — renal activationInability of the kidneys to convert vitamin D to its active form

inv-21: AGS serum 25(OH)D recommendation — minimum target for older adults

AGS serum 25(OH)D recommendationMinimum serum 25(OH)D concentration target of 30 ng/mL (75 nmol/L) for older adults

Revision History & Policy Changes

2025-06-01Removed diagnosis codesLatest

Applicable diagnosis codes list updated to remove E20.8, K91.1, K91.81, M85.811, M85.812, M85.821, M85.822, M85.831, M85.832, M85.841, M85.842, M85.851, M85.852, M85.861, M85.862, M85.871, M85.872, and M85.88; previous policy version MMP377.11 archived.