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Vitamin D Assay

Effective Date: January 01, 2019
Last Reviewed: July 16, 2019

Description

Vitamin D metabolites are used to assess serum vitamin D level and metabolism. Specifically, 25-hydroxy vitamin D, referred to as 25(OH)D, and 1,25-dihydroxyvitamin D. The 25 (OH)D metabolite has an estimated half-life of approximately two (2) to three (3) weeks, and provides a measure of the vitamin D originating from both dietary/supplement sources and from cutaneous(e.g. sun exposure) production. Vitamin D stored in other body tissues are, however, not reflected in the serum 25(OH)D levels. Serum levels of the active vitamin D metabolite, 1,25-dihydroxyvitamin D, may not accurately indicate the individual’s vitamin D status due to its short half-life (15 hours). Since it’s closely regulated by parathyroid hormone and the intake of calcium and phosphate, serum levels of 1,25-dihydroxyvitamin D may appear normal in individuals with vitamin D deficiency.

Vitamin D deficiency is defined as a 25(OH)D below 20 ng/ml (50 nmol/liter), and vitamin D insufficiency as a 25(OH)D of 21–29 ng/ml(525–725 nmol/liter).

Criteria

Measurement of cholecalciferol 25-hydroxyvitamin D [25 (OH) D] levels may be considered medically necessary for individuals with (not all inclusive):

  • Clinically documented underlying disease that is specifically associated with vitamin D deficiency, decreased bone density; or
  • Individuals considered at high risk for vitamin D deficiency (see list below) and vitamin D supplementation is being taken per the recommended daily amounts; or
    • African-American and Hispanic children and adults
    • Pregnant and lactating women
    • Older adults greater than 65 years with history of falls or non-traumatic fractures
    • Obesity; children and adults (BMI greater than or equal to 30)
  • Chronic kidney disease (CKD), stage 3 or greater; or
  • Granuloma forming diseases; or
    • Sarcoidosis
    • Tuberculosis
    • Histoplasmosis
    • Coccidiomycosis
    • Berylliosis
  • Hepatic disease or failure; or
  • Hyperparathyroidism; or
  • Long term use of anticonvulsants, glucocorticoids, rifampicin, acquired immune deficiency syndrome (aids) medications, antifungals, cholestyramine and other medications known to lower vitamin d levels; or
  • Malabsorption states; or
    • Cystic fibrosis
    • Inflammatory bowel disease (i.e. Crohn's disease, Ulcerative colitis)
    • Bariatric surgery
    • Radiation enteritis
  • Individuals receiving hyperalimentation; or
  • Osteomalacia; or
  • Osteoporosis or at risk for osteoporosis; or
  • Osteogenesis imperfecta; or
  • Rickets; or
  • Vitamin D deficiency on replacement therapy; to monitor the efficacy of treatment

25-OH Vitamin D-3 may be tested up to four (4) times per year for Vitamin D deficiencies when the above criteria are met.

Testing and screening for vitamin D deficiency with 25-hydroxyvitamin D [25(OH)D] serum testing is considered not medically necessary for all other indications.

Procedure Codes

82306

Measurement of 1,25(OH)2D may be considered medically necessary for evaluation of patients with a clinically documented underlying disease or condition associated with increased or decreased 1,25(OH)2D, including:

  • Chronic kidney disease; or
  • Hypercalcemia with a low parathyroid hormone; or
  • Acquired and/or inherited disorders in the metabolism of 25(OH)D and phosphate; or
  • Tumor induced osteomalacia (oncogenic osteomalacia); or
  • Hereditary phosphate-losing disorders; or
  • Vitamin D-dependent rickets type 1 (also known as pseudo-vitamin d deficient rickets); or
  • Vitamin D-resistant rickets; or
  • Chronic granuloma-forming disorders; or
  • Lymphomas.

Measurement of 1,25(OH)2D may be tested up to four (4) times per year for Vitamin D deficiencies when the above criteria is met.

With exception in very complex cases (e.g. hypercalcemia with reportedly low endogenous levels of 25-hydroxy vitamin D), there are rarely indications for ordering both 25-hydroxy vitamin D and1,25-dihydroxy vitamin D on the same specimen at the same time. In the presence of renal disease, 1,25-dihdroxy vitamin D levels may be needed to adequately assess vitamin D status.

Testing and screening for vitamin D deficiency with 1,25 dihydroxyvitamin D [1,25(OH)2D] serum testing is considered not medically necessary for all other indications.

Procedure Codes

82652

Professional Statements and Societal Positions Guidelines

Guidelines are in accordance with The Endocrine Society's Clinical Practice Guidelines: Treatment, and prevention of Vitamin D Deficiency. The Endocrine Society recommends screening for vitamin D deficiency in individuals at risk for deficiency. The society does not recommend population screening for vitamin D deficiency in individuals who are not at risk. It is recommended using the serum circulating 25-hydroxyvitamin D [25(OH)D] level, measured by a reliable assay to evaluate Vitamin D status in patients who are at risk for vitamin D deficiency. The society recommends using the serum 1,25-dihydroxyvitamin D [1,25(OH)2D] assay in monitoring certain conditions, such as acquired and inherited disorders of vitamin D and phosphate metabolism.

American Society for Clinical Pathology and Choosing Wisely recommends not performing population based screening for 25-OH-Vitanin D deficiency. Vitamin D deficiency is common in many populations, particularly in patients 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 patients. Laboratory testing is appropriate in higher risk patients when results will be used to institute more aggressive therapy (e.g., osteoporosis, chronic kidney disease, malabsorption, some infections, obese individuals).

Covered Diagnosis Codes for Procedure Code 82306

A15.0 A15.4 A15.5 A15.6 A15.7 A15.8 A17.0
A17.1 A17.81 A17.82 A17.83 A17.89 A18.09 A18.14
A18.16 A18.2 A18.4 A18.53 A18.54 A18.6 A18.7
A18.82 A18.84 A18.01 A18.02 A18.03 A18.11 A18.12
A18.13 A18.15 A18.17 A18.31 A18.32 A18.39 A18.51
A18.52 A18.59 A18.81 A18.83 A18.85 A18.89 A19.0
A19.1 A19.2 A19.8 A19.9 B38.0 B38.1 B38.2
B38.3 B38.4 B38.7 B38.81 B38.89 B39.0 B39.1
B39.3 B39.5 D86.0 D86.1 D86.2 D86.3 D86.9
D86.81 D86.82 D86.83 D86.84 D86.85 D86.86 D86.89
E20.0 E20.1 E.20.8 E20.9 E21.0 E21.1 E21.2
E21.3 E44.0 E46 E55.0 E55.9 E64.3 E66.8
E66.01 E66.09 E67.2 E67.8 E68 E83.00 E83.30
E83.31 E83.32 E83.39 E83.51 E83.52 E83.59 E84.0
E84.8 E84.9 E84.19 G73.7 J63.0 J63.1 J63.2
J63.3 J63.4 J63.5 J63.6 K50.00 K50.10 K50.011
K50.012 K50.013 K50.014 K50.018 K50.019 K51.00 K51.90
K52.0 K50.80 K50.90 K50.111 K50.112 K50.113 K50.114
K50.118 K50.119 K50.811 K50.812 K50.813 K50.814 K50.818
K50.819 K50.911 K50.912 K50.913 K50.914 K50.918 K50.919
K51.20 K51.30 K51.80 K51.011 K51.012 K51.013 K51.014
K51.018 K51.019 K51.211 K51.212 K51.213 K51.214 K51.218
K51.219 K51.311 K51.312 K51.313 K51.314 K51.318 K51.319
K70.0 K70.10 K70.11 K70.2 K70.30 K70.31 K70.40
K70.41 K70.9 K71.10 K71.11 K71.4 K71.50 K71.51
K71.6 K72.00 K72.01 K72.10 K72.11 K72.90 K72.91
K73.0 K73.1 K73.2 K73.8 K73.9 K74.0 K74.60
K74.69 K75.4 K74.1 K74.2 K74.3 K74.4 K74.5
K75.81 K76.0 K76.9 K76.89 K77 K83.01 K83.09
K83.1 K83.2 K83.3 K83.4 K83.5 K83.8 K83.9
K86.0 K86.1 K90.0 K90.1 K90.2 K90.3 K90.9
K90.41 K90.49 K90.81 K90.89 K91.2 M32.0 M32.8
M32.9 M32.10 M32.11 M32.12 M32.13 M32.14 M32.15
M32.19 M33.00 M33.01 M33.02 M33.03 M33.09 M33.10
M33.11 M33.12 M33.13 M33.19 M33.90 M33.91 M33.92
M33.93 M33.99 M60.80 M60.9 M60.88 M60.89 M62.81
M80.00XA M80.00XD M80.00XG M80.00XK M80.00XP M80.00XS M80.011A
M80.011D M80.011G M80.011K M80.011P M80.011S M80.012A M80.012D
M80.012G M80.012K M80.012P M80.012S M80.019A M80.019D M80.019G
M80.019K M80.019P M80.019S M80.021A M80.021D M80.021G M80.021K
M80.021P M80.021S M80.022A M80.022D M80.022G M80.022K M80.022P
M80.022S M80.029A M80.029D M80.029G M80.029K M80.029P M80.029S
M80.031A M80.031D M80.031G M80.031K M80.031P M80.031S M80.032A
M80.032D M80.032G M80.032K M80.032P M80.032S M80.039A M80.039D
M80.039G M80.039K M80.039P M80.039S M80.041A M80.041D M80.041G
M80.041K M80.041P M80.041S M80.042A M80.042D M80.042G M80.042K
M80.042P M80.042S M80.049A M80.049D M80.049G M80.049K M80.049P
M80.049S M80.051A M80.051D M80.051G M80.051K M80.051P M80.051S
M80.052A M80.052D M80.052G M80.052K M80.052P M80.052S M80.059A
M80.059D M80.059G M80.059K M80.059P M80.059S M80.061A M80.061D
M80.061G M80.061K M80.061P M80.061S M80.062A M80.062D M80.062G
M80.062K M80.062P M80.062S M80.069A M80.069D M80.069G M80.069K
M80.069P M80.069S M80.071A M80.071D M80.071G M80.071K M80.071P
M80.071S M80.072A M80.072D M80.072G M80.072K M80.072P M80.072S
M80.079A M80.079D M80.079G M80.079K M80.079P M80.079S M80.08XA
M80.08XD M80.08XG M80.08XK M80.08XP M80.08XS M80.80XA M80.80XD
M80.80XG M80.80XK M80.80XP M80.80XS M80.811A M80.811D M80.811G
M80.811K M80.811P M80.811S M80.812A M80.812D M80.812G M80.812K
M80.812P M80.812S M80.819A M80.819D M80.819G M80.819K M80.819P
M80.819S M80.821A M80.821D M80.821G M80.821K M80.821P M80.821S
M80.822A M80.822D M80.822G M80.822K M80.822P M80.822S M80.829A
M80.829D M80.829G M80.829K M80.829P M80.829S M80.831A M80.831D
M80.831G M80.831K M80.831P M80.831S M80.832A M80.832D M80.832G
M80.832K M80.832P M80.832S M80.839A M80.839D M80.839G M80.839K
M80.839P M80.839S M80.841A M80.841D M80.841G M80.841K M80.841P
M80.841S M80.842A M80.842D M80.842G M80.842K M80.842P M80.842S
M80.849A M80.849D M80.849G M80.849K M80.849P M80.849S M80.851A
M80.851D M80.851G M80.851K M80.851P M80.851S M80.852A M80.852D
M80.852G M80.852K M80.852P M80.852S M80.859A M80.859D M80.859G
M80.859K M80.859P M80.859S M80.861A M80.861D M80.861G M80.861K
M80.861P M80.861S M80.862A M80.862D M80.862G M80.862K M80.862P
M80.862S M80.869A M80.869D M80.869G M80.869K M80.869P M80.869S
M80.871A M80.871D M80.871G M80.871K M80.871P M80.871S M80.872A
M80.872D M80.872G M80.872K M80.872P M80.872S M80.879A M80.879D
M80.879G M80.879K M80.879P M80.879S M80.88XA M80.88XD M80.88XG
M80.88XK M80.88XP M80.88XS M81.0 M81.6 M81.8 M83.0
M83.1 M83.2 M83.3 M83.4 M83.5 M83.8 M83.9
M85.80 M85.811 M85.812 M85.819 M85.821 M85.822 M85.829
M85.831 M85.832 M85.839 M85.841 M85.842 M85.849 M85.851
M85.852 M85.859 M85.9 M85.88 M85.89 M85.861 M85.862
M85.869 M85.871 M85.872 M85.879 M89.9 M94.9 N18.3
N18.4 N18.5 N18.6 P37.0 P71.0 P71.1 P71.2
P71.3 P71.4 P71.8 P71.9 Q78.0 Q78.2 Z34.82
Z68.30 Z68.31 Z68.32 Z68.33 Z68.34 Z68.35 Z68.36
Z68.37 Z68.38 Z68.39 Z68.41 Z68.42 Z68.43 Z68.44
Z68.45 Z68.54 Z79.51 Z79.52 Z79.899 Z98.84

Covered Diagnosis Codes for Procedure Code 82652

A15.0 A15.4 A15.5 A15.6 A15.7 A15.8 A17.0
A17.1 A17.9 A17.81 A17.82 A17.89 A18.2 A18.4
A18.6 A18.7 A18.01 A18.02 A18.03 A18.10 A18.11
A18.12 A18.13 A18.15 A18.17 A18.31 A18.32 A18.39
A18.50 A18.51 A18.52 A18.59 A18.81 A18.83 A18.85
A18.89 A19.0 A19.1 A19.2 A19.8 A19.9 B38.0
B38.1 B38.2 B38.7 B38.9 B38.89 B39.4 C81.00
C81.01 C81.02 C81.04 C81.05 C81.06 C81.07 C81.08
C81.09 C81.10 C81.11 C81.12 C81.13 C81.14 C81.15
C81.16 C81.17 C81.18 C81.19 C81.20 C81.21 C81.22
C81.23 C81.24 C81.25 C81.26 C81.27 C81.28 C81.29
C81.30 C81.31 C81.32 C81.33 C81.34 C81.36 C81.37
C81.38 C81.40 C81.41 C81.42 C81.44 C81.45 C81.46
C81.47 C81.48 C81.49 C81.70 C81.71 C81.72 C81.73
C81.74 C81.75 C81.76 C81.77 C81.78 C81.79 C81.90
C81.91 C81.92 C81.93 C81.94 C81.95 C81.96 C81.97
C81.98 C81.99 C82.00 C82.01 C82.02 C82.03 C82.04
C82.05 C82.06 C82.07 C82.08 C82.13 C82.14 C82.15
C82.16 C82.17 C82.18 C82.22 C82.23 C82.24 C82.25
C82.26 C82.27 C82.28 C82.31 C82.32 C82.33 C82.34
C82.35 C82.36 C82.37 C82.38 C82.41 C82.42 C82.43
C82.44 C82.45 C82.46 C82.47 C82.48 C82.50 C82.51
C82.52 C82.53 C82.54 C82.55 C82.56 C82.58 C82.59
C82.60 C82.61 C82.62 C82.63 C82.64 C82.65 C82.66
C82.67 C82.68 C82.69 C82.80 C82.81 C82.82 C82.83
C82.84 C82.85 C82.86 C82.87 C82.88 C82.89 C82.90
C82.92 C82.91 C82.93 C82.94 C82.95 C82.96 C82.97
C82.98 C82.99 C83.00 C83.01 C83.02 C83.03 C83.04
C83.05 C83.06 C83.07 C83.08 C83.09 C83.10 C83.11
C83.12 C83.13 C83.14 C83.15 C83.16 C83.17 C83.18
C83.19 C83.30 C83.31 C83.32 C83.33 C83.34 C83.35
C83.36 C83.37 C83.38 C83.39 C83.50 C83.51 C83.52
C83.53 C83.54 C83.55 C83.56 C83.57 C83.58 C83.59
C83.70 C83.71 C83.72 C83.73 C83.74 C83.75 C83.76
C83.77 C83.78 C83.79 C83.80 C83.81 C83.82 C83.83
C83.84 C83.85 C83.86 C83.87 C83.88 C83.89 C83.90
C83.91 C83.92 C83.93 C83.94 C83.95 C83.96 C83.97
C83.98 C83.99 C84.00 C84.01 C84.02 C84.03 C84.04
C84.05 C84.07 C84.08 C84.09 C84.10 C84.11 C84.12
C84.13 C84.14 C84.15 C84.16 C84.17 C84.18 C84.19
C84.40 C84.43 C84.44 C84.45 C84.47 C84.48 C84.49
C84.65 C84.66 C84.67 C84.68 C84.75 C84.76 C84.77
C84.78 C84.79 C84.90 C84.91 C84.92 C84.93 C84.94
C84.95 C84.96 C84.98 C84.99 C84.A0 C84.A1 C84.A2
C84.A3 C84.A4 C84.A5 C84.A6 C84.A7 C84.A8 C84.A9
C84.Z0 C84.Z1 C84.Z2 C84.Z3 C84.Z4 C84.Z5 C84.Z6
C84.Z7 C84.Z8 C84.Z9 C85.10 C85.11 C85.12 C85.13
C85.14 C85.16 C85.18 C85.19 C85.20 C85.21 C85.22
C85.23 C85.24 C85.25 C85.26 C85.27 C85.28 C85.29
C85.80 C85.81 C85.82 C85.83 C85.84 C85.85 C85.86
C85.88 C85.89 C85.90 C85.91 C85.92 C85.93 C85.94
C85.95 C85.96 C85.98 C85.99 C86.0 C86.2 C86.3
C86.4 C86.5 C86.6 C88.4 C91.40 C91.41 C91.42
C96.0 C96.2 C96.21 C96.22 C96.29 C96.4 C96.9
C96.A C96.Z D71 E55.0 E55.9 E83.00 E83.30
E83.31 E83.32 E83.39 E83.50 E83.51 E83.52 E83.59
M83.0 M83.1 M83.2 M83.4 M83.5 M83.8 M83.9
N18.3 N18.4 N18.5 N18.6

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