L30868

 

VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED

 

06/07/2010

 

Indications and Limitations of Coverage and/or Medical Necessity

 

Indications

 

FCSO Medicare will consider the measurement of 25(OH) D Vitamin D levels medically reasonable and necessary for patients with any of the following conditions:

• Chronic kidney disease stage III or greater.

• Hypercalcemia.

• Hypocalcemia.

• Hyperparathyroidism.

• Hypoparathyroidism.

• Osteomalacia.

• Osteoporosis.

• Osteopenia.

• Rickets.

• Vitamin D deficiency to monitor the efficacy of replacement therapy.

• Malabsorption states.

• Cirrhosis.

Limitations

• Vitamin D assay testing is NOT covered for routine screening; therefore, preventive care is not recognized as a covered indication for Vitamin D serum testing.

o Tests that are performed in the absence of signs, symptoms, complaints, personal history of disease, or injury are not covered by Medicare except when there is a statutory provision that explicitly covers tests for screening as described in the manual.

• This LCD outlines the indications for vitamin D, 25-hydroxy (CPT code 82306).

o This test is appropriate for assessment of vitamin D deficiency. Vitamin D, 1, 25-dihydroxy (CPT code 82652) is primarily indicated during patient evaluations for hypercalcemia and renal failure.

o It should not be ordered in addition to vitamin D, 25-hydroxy for vitamin D deficiency testing.

 

 

CPT/HCPCS Codes

 

 

82306 VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED

 

 

ICD-9 Codes that Support Medical Necessity

 

252.00 HYPERPARATHYROIDISM, UNSPECIFIED

252.01 PRIMARY HYPERPARATHYROIDISM

252.02 SECONDARY HYPERPARATHYROIDISM, NON-RENAL

252.08 OTHER HYPERPARATHYROIDISM

252.1 HYPOPARATHYROIDISM

268.0 RICKETS ACTIVE

268.2 OSTEOMALACIA UNSPECIFIED

268.9 UNSPECIFIED VITAMIN D DEFICIENCY

275.3 DISORDERS OF PHOSPHORUS METABOLISM

275.41 HYPOCALCEMIA

275.42 HYPERCALCEMIA

278.4 HYPERVITAMINOSIS D

571.2 ALCOHOLIC CIRRHOSIS OF LIVER

571.5 CIRRHOSIS OF LIVER WITHOUT ALCOHOL

571.6 BILIARY CIRRHOSIS

579.0 CELIAC DISEASE

579.1 TROPICAL SPRUE

579.2 BLIND LOOP SYNDROME

579.3 OTHER AND UNSPECIFIED POSTSURGICAL NONABSORPTION

579.4 PANCREATIC STEATORRHEA

579.8 OTHER SPECIFIED INTESTINAL MALABSORPTION

579.9 UNSPECIFIED INTESTINAL MALABSORPTION

585.3 CHRONIC KIDNEY DISEASE, STAGE III (MODERATE)

585.4 CHRONIC KIDNEY DISEASE, STAGE IV (SEVERE)

585.5 CHRONIC KIDNEY DISEASE, STAGE V

585.6 END STAGE RENAL DISEASE

588.81 SECONDARY HYPERPARATHYROIDISM (OF RENAL ORIGIN)

733.00 OSTEOPOROSIS UNSPECIFIED

733.01 SENILE OSTEOPOROSIS

733.02 IDIOPATHIC OSTEOPOROSIS

733.03 DISUSE OSTEOPOROSIS

733.09 OTHER OSTEOPOROSIS

733.90 DISORDER OF BONE AND CARTILAGE UNSPECIFIED

 

 

Documentation Requirements

 

• Medical record documentation must support the medical necessity of vitamin D testing.

• The results of the vitamin D testing and the resulting treatment regimen must be documented in the patient’s medical record.

• This information includes, but is not limited to relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures usually found in hospital/office progress notes and written laboratory reports.

 

Utilization Guidelines

• For vitamin D deficiency, further testing may be medically reasonable and necessary in some cases, when utilized to ensure adequate replacement has been accomplished for the vitamin deficiency, however, other parameters are generally measured.

 

Treatment Logic

• Vitamin D, a group of fat-soluble prohormones, is an essential vitamin.

• There are two major types of Vitamin D (Vitamin D2 and Vitamin D3) which are collectively known as calciferol.

• They are essential for promoting calcium absorption and maintaining adequate serum calcium and phosphate concentrations to enable mineralization of bone and prevent hypocalcemic conditions.

• Vitamin D2 (ergocalciferol) is obtained from foods of plant origin and vitamin D3 (cholecalciferol) is obtained from foods of animal origin and ultraviolet light-stimulated conversion of 7-dehydrocholestral in the skin.

• Vitamin D is stored in the human body as calcidiol (25-hydroxyvitamin D). Serum concentration of 25(OH) D is the best indicator of vitamin D status.

• Vitamin D deficiencies are the result of dietary inadequacy, impaired absorption and use, increased requirement, or increased excretion.

• Vitamin D deficiency can occur when usual intake is lower than recommended levels over a period of time, or when exposure to sunlight is limited.

• Vitamin D deficiency can also result from the inability of the kidneys to convert the vitamin D to its active form.

• Vitamin D toxicity can cause symptoms including nausea, vomiting, poor appetite, constipation, weakness, and weight loss as well as elevation in the blood level of calcium which in turn can lead to mental status changes, and heart rhythm abnormalities.

 

 

Sources of Information and Basis for Decision

 

Bishoff-Ferrari, H.A., Dawson-Hughes, B., Willet, W., et al. Effect of vitamin D on falls: a meta-analysis JAMA. April 2004; 291:16:1999-2006. Retrieved December 29, 2009 from www.jama.com

 

Bishoff-Ferrari, H.A., Willett, W., Wong, J., Giovannucci, E., Eietrich, T., Dawson-Hughes, B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. May 2005; 293:18:2257-2264. Retrieved December 29, 2009 from www.jama.com

 

Clinician’s Guide to Prevention and Treatment of Osteoporosis. (2008). National Osteoporosis Foundation. Retrieved October 26, 2009 from www.nof.org

 

Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. (2004). National Kidney Foundation. Retrieved October 26, 2009 from www.kidney.org/professionals

 

FCSO LCD 30868, Vitamin D; 25 hydroxy, includes fraction(s), if performed, 06/07/2010. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

Nichols, J. The controversy surrounding vitamin D lab testing. Washington G-2 Reports. (2008). Retrieved October 22, 2009 from www.g2reports.com/issues/advisory/advisory/james_nichols/422-1.html

 

Office of Dietary Supplements, National Institutes of Health: Dietary Supplement Fact Sheet: Vitamin D. (2005) Retrieved December 23, 2009 from www.ods.od.nih.gov/factsheets/vitamind.asp

 

 

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2012 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

CMS LCD L30868 VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED