Criteria
Coverage is subject to the specific terms of the member's benefit plan.
Vitamin D testing may be considered medically necessary when ONE or more the following conditions are met:
- In asymptomatic individuals when ONE or more of the following criteria are met:
- Individuals who have risk factors for vitamin D deficiency when ONE or more of the following criteria are met:
- Chronic kidney disease stage III-V and End Stage Renal Disease; or
- Cirrhosis and chronic liver disease; or
- Malabsorption states; or
- Osteomalacia; or
- Osteoporosis; or
- Rickets; or
- Hypo- or hypercalcemia; or
- Granulomatous diseases; or
- Obstructive jaundice and biliary tract disease; or
- Osteogenesis imperfecta; or
- Osteosclerosis and osteopetrosis; or
- Chronic use of anticonvulsant medication or corticosteroids; or
- Parathyroid disorders; or
- Osteopenia; or
- Individuals with signs or symptoms of vitamin D deficiency OR toxicity when ONE or more of the following criteria are met:
- Clinical diagnosis of an abnormality in bone health; or
- Individual has an unexplained abnormality in ONE or more of the following serum levels:
- Calcium
- Phosphorus
- Alkaline phosphatase
- Parathyroid Hormone
Routine screening for Vitamin D deficiency in asymptomatic individuals is considered not medically necessary.
Procedure Codes
Quantity Level Limits (QLL) for Vitamin D testing
Vitamin D testing is only reimbursable once per benefit year. Subsequent testing will not be reimbursed.
Quantity level limits (QLLs) that exceed the frequency guidelines listed on the policy are considered not medically necessary.
Professional Statements and Societal Positions Guidelines
Endocrine Society (2011, updated in 2024)
The Endocrine Society published its guideline "Vitamin D for the Prevention of Disease," in 2024. This guideline recommends universal vitamin D supplementation rather than universal or targeted screening.
The Endocrine Society published clinical practice guidelines on the evaluation, treatment, and prevention of vitamin D deficiency. The following recommendations were made regarding testing vitamin D levels:
- 25-hydroxy vitamin D serum level testing is recommended: "to evaluate vitamin D status only in individuals who are at risk of deficiency." The guideline did not recommend screening of individuals not at risk of vitamin D deficiency.
- 1,25-dihydroxyvitamin D testing was not recommended to evaluate vitamin D status. However, the guideline did recommend monitoring calcitriol levels under certain conditions.
U.S. Preventive Services Task Force Recommendations 2021
The U.S. Preventive Services Task Force published an updated recommendation, and associated evidence report and systematic review in 2021, on vitamin D screening. The Task Force concluded that the current evidence was insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic individuals (grade I [insufficient evidence]).
The American Society of Clinical Pathology (ASCP, 2020)
The ASCP (2020) recommended the following for Choosing Wisely(R):
"Vitamin D deficiency is common in many populations, particularly in individuals at higher latitudes, during winter months and in those with limited sun exposure. Over the counter Vitamin D supplements and increased summer sun exposure are sufficient for most otherwise healthy individuals. Laboratory testing is appropriate in higher risk individuals when results will be used to institute more aggressive therapy (e.g., osteoporosis, chronic kidney disease, malabsorption, some infections, obese individuals)."
ND Committee Review
Internal Medical Policy Committee 5-13-2025 New Policy - Effective July 07, 2025
- Adoption of new policy; and
- Added Policy Application.
