Coverage of Conditions and Treatments (Coverage Decisions)
Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.
List also available in PDF format.
See Treatment Guidelines and Resources for additional information.
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