CurrentUnitedHealthcarePolicy 2026R5040A

Vitamin D testing reimbursement

Defines UnitedHealthcare reimbursement policy for Vitamin D laboratory testing billed on CMS-1500 or UB04 forms for Commercial and Individual Exchange products; applies to network and non-network providers and outpatient facilities.

Policy Summary

PayerUnitedHealthcare

PolicyVitamin D testing reimbursement

Policy CodePolicy 2026R5040A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSubmit up to four Vitamin D tests per year with an appropriate ICD-10 diagnosis from the policy list to be considered for reimbursement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

up to fourVitamin D tests reimbursed per member per year

3listed CPT/HCPCS codes for Vitamin D testing

ICD-10 listdiagnosis codes required to support reimbursement

CMS-1500 / UB04claim forms to which policy applies

Vitamin D Testing Coverage Criteria

Vitamin D testing coverage criteria

Reimbursement criteria for Vitamin D testing.

ALL of the following

ALL of the following
- Claim includes an ICD-10 diagnosis code from the CMS Vitamin D Testing diagnosis list OR one of the additional diagnosis codes added by UnitedHealthcare.
  Tests without a diagnosis from the Vitamin D Testing diagnosis list will be denied.
ALL of the following
- The billed procedure code is one of the Vitamin D test codes listed in the policy (e.g., 82306, 82652, 0038U).
ALL of the following

Policy Summary

PayerUnitedHealthcare

PolicyVitamin D testing reimbursement

Policy CodePolicy 2026R5040A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSubmit up to four Vitamin D tests per year with an appropriate ICD-10 diagnosis from the policy list to be considered for 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.

UnitedHealthcare will consider reimbursement for up to 4 Vitamin D tests per member per year when submitted with an appropriate diagnosis code.

Up to four tests per year will be considered for reimbursement.

Clinical justification (context): Laboratory testing is appropriate in higher-risk patients when results will be used to institute more aggressive therapy; measurement of 25(OH)D is reasonable in patients at risk of deficiency or 3-4 months after supplementation to assess dose adequacy.

CPT / HCPCS Codes and Test Limits

Vitamin D testing CPT/HCPCSCPTCovered

82306	25-hydroxyvitamin D
82652	1,25-dihydroxyvitamin D
0038U	Vitamin D test (specified)

Annual test limit — Vitamin D testing

LimitUp to 4 Vitamin D tests per member per year reimbursed when submitted with an appropriate ICD-10 diagnosis code (CMS list plus UnitedHealthcare additions)

Denial conditionTests without a diagnosis from the Vitamin D Testing diagnosis list will be denied.

Claim formsApplies to claims billed on CMS-1500 and UB04 forms.

Policy number2026R5040A

Documentation, Prior Authorization, and Billing Guidance

Prior Authorization

Prior Authorization and Documentation Guidance

Prior authorization is not required for vitamin D laboratory testing; however, providers must submit an appropriate ICD-10 diagnosis code from the ICD-10 Vitamin D Testing List with the claim. UnitedHealthcare will consider reimbursement for up to four Vitamin D tests per member per year when an appropriate ICD-10 diagnosis code is submitted in any position. Claims for Vitamin D tests that do not include a diagnosis from the Vitamin D Testing List will be denied. Document clinical rationale in the chart (risk factors, intended clinical use of results, or plan to alter therapy based on results) to support medical necessity consistent with guideline recommendations (for example: initial measurement in patients at risk of deficiency or follow-up measurement 3–4 months after supplementation to assess dose adequacy).

Reimbursement limit: up to 4 Vitamin D tests per member per year.
Required documentation: clinical rationale in the medical record (risk factors, treatment plan, expected use of results).
Claim submission: include an ICD-10 code from the ICD-10 Vitamin D Testing List in any diagnosis position.
Denial condition: tests submitted without an ICD-10 code from the Vitamin D Testing List will be denied.

Key Definitions

Vitamin D testing — definition

Test definition25(OH)D testing (measurement of 25-hydroxyvitamin D)

Clinical contextInitial measurement recommended for patients at risk of deficiency or after supplementation to assess dose adequacy (3–4 months).

Appropriate useLaboratory testing appropriate in higher-risk patients when results will be used to institute more aggressive therapy.