Coverage of Conditions and Treatments (Coverage Decisions)
Several clinical factors suggest the potential for vitamin D insufficiency or deficiency and thus may be indicators for vitamin D testing.
Vitamin D testing is not covered as a part of routine screening.
Vitamin D testing requires prior authorization, and is covered benefit in individuals with the following conditions that are accepted on the claim:
- A disease or condition known to cause, or be caused by, Vitamin D abnormality; or
- Radiologic or laboratory findings positive for markers of Vitamin D abnormality; including specifically:
- *blind loop syndrome
- *celiac disease
- chronic kidney disease
- end stage renal disease
- hypervitaminosis D
- hypo or hypercalcemia
- hypocalcemia and hypomagnesmia of newborn
- secondary hyperparathyroidism
- intestinal malabsorption
- pancreatic steatorrhea
*Covered only after diagnosis is established
Background Policy Information
The State Health Technology Clinical Committee (HTCC) reviewed Vitamin D testing on September 21, 2012. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that Vitamin D testing is a covered benefit with conditions consistent with the criteria identified in the reimbursement determination. Complete information on this HTCC determination is available here: What we're working on | Washington State Health Care Authority
Implementation of this Determination
Beginning July 15, 2013 all requests for Vitamin D testing require prior authorization and will be reviewed by claims manager for State Fund Claims.
Billing CPT ® Codes
- 82306 - Assay of Vitamin D
- 82652 - Assay of Dihydroxy-Vitamin D