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LCD for Vitamin D Assay Testing (L37535)


Contractor Information

Contractor Name Contract Type Contract Number Jurisdiction State(s)
National Government Services, Inc. MAC - Part A 06101 - MAC A J - 06 Illinois
National Government Services, Inc. MAC - Part B 06102 - MAC B J - 06 Illinois
National Government Services, Inc. MAC - Part A 06201 - MAC A J - 06 Minnesota
National Government Services, Inc. MAC - Part B 06202 - MAC B J - 06 Minnesota
National Government Services, Inc. MAC - Part A 06301 - MAC A J - 06 Wisconsin
National Government Services, Inc. MAC - Part B 06302 - MAC B J - 06 Wisconsin
National Government Services, Inc. A and B and HHH MAC 13101 - MAC A J - K Connecticut
National Government Services, Inc. A and B and HHH MAC 13102 - MAC B J - K Connecticut
National Government Services, Inc. A and B and HHH MAC 13201 - MAC A J - K New York - Entire State
National Government Services, Inc. A and B and HHH MAC 13202 - MAC B J - K New York - Downstate
National Government Services, Inc. A and B and HHH MAC 13282 - MAC B J - K New York - Upstate
National Government Services, Inc. A and B and HHH MAC 13292 - MAC B J - K New York - Queens
National Government Services, Inc. A and B and HHH MAC 14111 - MAC A J - K Maine
National Government Services, Inc. A and B and HHH MAC 14112 - MAC B J - K Maine
National Government Services, Inc. A and B and HHH MAC 14211 - MAC A J - K Massachusetts
National Government Services, Inc. A and B and HHH MAC 14212 - MAC B J - K Massachusetts
National Government Services, Inc. A and B and HHH MAC 14311 - MAC A J - K New Hampshire
National Government Services, Inc. A and B and HHH MAC 14312 - MAC B J - K New Hampshire
National Government Services, Inc. A and B and HHH MAC 14411 - MAC A J - K Rhode Island
National Government Services, Inc. A and B and HHH MAC 14412 - MAC B J - K Rhode Island
National Government Services, Inc. A and B and HHH MAC 14511 - MAC A J - K Vermont
National Government Services, Inc. A and B and HHH MAC 14512 - MAC B J - K Vermont

LCD Information

Document Information

LCD ID

L37535

LCD Title

Vitamin D Assay Testing

Proposed LCD in Comment Period

N/A

Source Proposed LCD

DL37535

Original Effective Date

For services performed on or after 04/01/2018

Revision Effective Date

N/A

Revision Ending Date

N/A

Retirement Date

N/A

Notice Period Start Date

02/14/2018

Notice Period End Date

03/31/2018

AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT only copyright 2002-2016 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright © American Dental Association. All rights reserved. CDT and CDT-2016 are trademarks of the American Dental Association.

UB-04 Manual. OFFICIAL UB-04 DATA SPECIFICATIONS MANUAL, 2014, is copyrighted by American Hospital Association (“AHA”), Chicago, Illinois. No portion of OFFICIAL UB-04 MANUAL may be reproduced, sorted in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior express, written consent of AHA.” Health Forum reserves the right to change the copyright notice from time to time upon written notice to Company.

CMS National Coverage Policy

Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.

Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.

Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider for any claim that lacks the necessary information to process the claim.

42CFR410.32(a) requires a clinical diagnostic test be ordered by the physician who is treating the patient for a specific medical problem and uses the results in the management of the beneficiary’s specific problem.

MBPM Internet Only Manual (IOM 100-02), Chapter 6, Section 20.4.3 applies 42CFR410.32 to hospitals.


Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

Hypovitaminosis D may result from inadequate intake, insufficient sunlight, malabsorption, liver, kidney and genetic disease. It results in the inadequate mineralization of bone. The CDC reported approximately 300,000 hip fractures, 60,000 fall-related deaths and 33 billion dollars in health care expenditures in 2014. This LCD identifies the indications and limitations of Medicare coverage for Vitamin D; 25 hydroxy and Vitamin D; 1, 25 dihydroxy laboratory assays in the medical management of patients. 

Indications:

Measurement of 25-OH Vitamin D, CPT 82306, level is indicated for patients with:

    • chronic kidney disease stage III or greater
    • cirrhosis
    • hypocalcemia
    • hypercalcemia
    • hypercalciuria
    • hypervitaminosis D
    • parathyroid disorders
    • malabsorption states
    • obstructive jaundice
    • osteomalacia
    • osteoporosis if:

      i. T score on DEXA scan <-2.5 or

      ii. History of fragility fractures or

      iii. FRAX> 3% 10-year probability of hip fracture or 20% 10-year probability of other major osteoporotic fracture or

      iv. FRAX> 3% (any fracture) with T-score <-1.5 or

      v. Initiating bisphosphanate therapy (Vitamin D level and serum calcium levels should be determined and managed as necessary before bisphosphonate is initiated.)

    • osteosclerosis/petrosis
    • rickets
    • vitamin D deficiency on replacement therapy related to a condition listed above; to monitor the efficacy of treatment.

Measurement of 1, 25-OH Vitamin D, CPT 82652, level is indicated for patients with:

    • unexplained hypercalcemia (suspected granulomatous disease or lymphoma)
    • unexplained hypercalciuria (suspected granulomatous disease or lymphoma)
    • suspected genetic childhood rickets
    • suspected tumor-induced osteomalacia
    • nephrolithiasis or hypercalciuria

Limitations:

  • Both assays of vitamin D need not be performed for each of the above conditions.
  • Once a beneficiary has been shown to be vitamin D deficient, further testing may be medically necessary only to ensure adequate replacement has been accomplished.
  • If Vitamin D level is between 20 and 50 ng/dl and patient is clinically stable, repeat testing is often unnecessary; if performed, documentation must clearly indicate the necessity of the test.
  • If level <20 ng/dl or > 60 ng/dl are noted, a subsequent level(s) may be reimbursed until the level is within the normal range.
  • Testing may not be used for routine or other screening.

Summary of Evidence

Routine use of laboratory assays to document Vitamin D deficiency remains controversial. The current United States Preventive Health Service Task Force recommendations consider current medical evidence insufficient to assess the balance of benefits and harms of screening for Vitamin D deficiency in asymptomatic adults. However, one major meta-analysis (one with five pooled randomized controlled trials including 1237 patients) concluded that Vitamin D supplementation reduced the risk of falls among ambulatory and institutionalized older individuals with stable health by more than 20%.

A second meta-analysis pooled 12 randomized controlled trials, all using cholecalciferol supplementation therapy between 700-800 IU/d. The results demonstrated a reduction in fractures of the hip of 26%, and non-vertebral fractures of 23%, in both ambulatory and institutionalized elderly persons.

There is also controversy as to the definition of vitamin D sufficiency, although many authors accept a level of 25(OH)D of at least 30 ng/ml.  Accepting this metric, 25-50% of nursing home or homebound patients, greater than 50% of hospitalized patients and 30% of women with osteoporosis may still have Vitamin D deficiency despite a growing societal awareness of that deficiency as a contributing factor. 

In 2009, the Agency for Healthcare Research and Quality, through the Tufts Evidenced Based Practice Center, conducted a systematic review of the scientific literature on Vitamin D and calcium intake as related to status indicators and health outcomes. This original report summarized 165 articles and 11 systematic reviews that incorporated 200 additional primary articles.   In 2013, in preparation for a project in conjunction with the NIH Office of Dietary Supplements, the report was updated to include 154 new articles. Despite this effort, disagreement exists regarding Vitamin D optimum dosing, target 25(OH) vitamin D levels and the reported associations with health outcomes. Associations with cardiovascular disease, major cancers breast, prostate, colorectal and pancreatic were mixed and inconclusive. One RCT found a small effect on fall risk among older adults. As described in the original report, both the Tufts EPC and the Ottawa EPC data found good evidence that combined Vitamin D3 (200-800 IU/d) plus calcium 500mg/d supplementation resulted in a small increase in Bone Mineral Density of the spine, the total body, femoral neck and total hip. 

Another AHRQ funded study, LeBlanc et al Screening for Vitamin D deficiency: A Systematic Review for the US Preventive Services Task Force (Jan. 2015) concluded that screening for Vitamin D levels in asymptomatic persons might reduce mortality risk in institutionalized elderly persons and risk for falls, but not fractures. The authors noted the inconsistency of laboratory methodology and reporting, and a lack of consensus regarding optimal 25(OH) D levels. 

In its 2011 report, the Institute of Medicine shared the concerns that a “reassessment of laboratory ranges for 25-hydroxyvitamin D” was needed to decrease risks of over and under treatment of Vitamin D deficiency. 

A pragmatic approach for patients and their physicians was developed by the ABIM Foundation in its Choosing Wisely initiative. The patient friendly literature reassures individuals that healthy diet and exercise maintain most persons in an adequate range of Vitamin D level. It raises the possible justification of empiric vitamin D supplementation without testing for those patients without risk factors but may be thought to have inadequate sun exposure or dietary intake, while outlining those clinical risk factors that warrant baseline diagnostic assays.

Analysis of Evidence
(Rationale for Determination)

It is established that 25-hydroxyvitamin D is more reflective of total body stores of vitamin D than the shorter lived, active metabolite, 1,25 dihydroxyvitamin D. Although lack of laboratory standardization is commonly noted in most papers, it is the preferred initial assay in the evaluation of most patients with hypovitaminosis D.  The 25-hydroxyvitamin D undergoes additional hydroxylation in the kidney by 1- alphahydroxylase under the influence of parathyroid hormone to produce the active metabolite. The 1,25 dihydroxyvitamin D assay is reserved for those patients where a contributory medical illness generally related to kidney disease, but also possibly related to liver, parathyroid or genetic diseases that may influence this normal metabolism.   

The benefits of treatment of Vitamin D supplementation may be modest, and those benefits made difficult to quantify by general health, habits such as exercise and smoking, and other contributory factors such as ethnicity and medication treatment regimens.    

However, the prevalence of osteoporosis, fall risk and skeletal fractures, and the general tolerance of the current recommended daily requirements mitigate for early supplementation in any individual uncertain regarding adequate dietary intake and sunlight exposure.   

Once a beneficiary has been shown to be Vitamin D deficient, by assay or clinical findings, the correctly chosen assay (25 hydroxyvitamin D, or 1,25 di-hydroxyvitamin D) may be used to assure correct supplementation to attain the serum levels outlined in Limitations. Continued findings outside those parameters (again outlined in the Limitations section) may warrant additional testing.   


Coding Information

Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

Bill Type Code Description
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
085x Critical Access Hospital
999x Not Applicable

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

Revenue Code Description
0300 Laboratory - General Classification
0301 Laboratory - Chemistry
0309 Laboratory - Other Laboratory

CPT/HCPCS Codes

Group 1 Paragraph:

Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural Terminology (CPT) codes.

Group 1 Codes:

CPT/HCPCS Code Description
82306 VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED
82652 VITAMIN D; 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED

ICD-10 Codes that Support Medical Necessity

Group 1 Paragraph:

The following ICD-10-CM codes support the medical necessity of CPT code 82306

Group 1 Codes:

ICD-10 Code Description
A15.0 Tuberculosis of lung
A15.4 Tuberculosis of intrathoracic lymph nodes
A15.5 Tuberculosis of larynx, trachea and bronchus
A15.6 Tuberculous pleurisy
A15.7 Primary respiratory tuberculosis
A15.8 Other respiratory tuberculosis
A17.0 Tuberculous meningitis
A17.1 Meningeal tuberculoma
A17.81 Tuberculoma of brain and spinal cord
A17.82 Tuberculous meningoencephalitis
A17.83 Tuberculous neuritis
A17.89 Other tuberculosis of nervous system
A18.01 Tuberculosis of spine
A18.02 Tuberculous arthritis of other joints
A18.03 Tuberculosis of other bones
A18.09 Other musculoskeletal tuberculosis
A18.11 Tuberculosis of kidney and ureter
A18.12 Tuberculosis of bladder
A18.13 Tuberculosis of other urinary organs
A18.14 Tuberculosis of prostate
A18.15 Tuberculosis of other male genital organs
A18.16 Tuberculosis of cervix
A18.17 Tuberculous female pelvic inflammatory disease
A18.18 Tuberculosis of other female genital organs
A18.2 Tuberculous peripheral lymphadenopathy
A18.31 Tuberculous peritonitis
A18.32 Tuberculous enteritis
A18.39 Retroperitoneal tuberculosis
A18.4 Tuberculosis of skin and subcutaneous tissue
A18.51 Tuberculous episcleritis
A18.52 Tuberculous keratitis
A18.53 Tuberculous chorioretinitis
A18.54 Tuberculous iridocyclitis
A18.59 Other tuberculosis of eye
A18.6 Tuberculosis of (inner) (middle) ear
A18.7 Tuberculosis of adrenal glands
A18.81 Tuberculosis of thyroid gland
A18.82 Tuberculosis of other endocrine glands
A18.83 Tuberculosis of digestive tract organs, not elsewhere classified
A18.84 Tuberculosis of heart
A18.85 Tuberculosis of spleen
A18.89 Tuberculosis of other sites
A19.0 Acute miliary tuberculosis of a single specified site
A19.1 Acute miliary tuberculosis of multiple sites
A19.2 Acute miliary tuberculosis, unspecified
A19.8 Other miliary tuberculosis
B38.0 Acute pulmonary coccidioidomycosis
B38.1 Chronic pulmonary coccidioidomycosis
B38.3 Cutaneous coccidioidomycosis
B38.4 Coccidioidomycosis meningitis
B38.7 Disseminated coccidioidomycosis
B38.81 Prostatic coccidioidomycosis
B38.89 Other forms of coccidioidomycosis
B39.0 Acute pulmonary histoplasmosis capsulati
B39.1 Chronic pulmonary histoplasmosis capsulati
B39.3 Disseminated histoplasmosis capsulati
B39.5 Histoplasmosis duboisii
C82.01 Follicular lymphoma grade I, lymph nodes of head, face, and neck
C82.02 Follicular lymphoma grade I, intrathoracic lymph nodes
C82.03 Follicular lymphoma grade I, intra-abdominal lymph nodes
C82.04 Follicular lymphoma grade I, lymph nodes of axilla and upper limb
C82.05 Follicular lymphoma grade I, lymph nodes of inguinal region and lower limb
C82.06 Follicular lymphoma grade I, intrapelvic lymph nodes
C82.07 Follicular lymphoma grade I, spleen
C82.08 Follicular lymphoma grade I, lymph nodes of multiple sites
C82.09 Follicular lymphoma grade I, extranodal and solid organ sites
C82.11 Follicular lymphoma grade II, lymph nodes of head, face, and neck
C82.12 Follicular lymphoma grade II, intrathoracic lymph nodes
C82.13 Follicular lymphoma grade II, intra-abdominal lymph nodes
C82.14 Follicular lymphoma grade II, lymph nodes of axilla and upper limb
C82.15 Follicular lymphoma grade II, lymph nodes of inguinal region and lower limb
C82.16 Follicular lymphoma grade II, intrapelvic lymph nodes
C82.17 Follicular lymphoma grade II, spleen
C82.18 Follicular lymphoma grade II, lymph nodes of multiple sites
C82.19 Follicular lymphoma grade II, extranodal and solid organ sites
C82.21 Follicular lymphoma grade III, unspecified, lymph nodes of head, face, and neck
C82.22 Follicular lymphoma grade III, unspecified, intrathoracic lymph nodes
C82.23 Follicular lymphoma grade III, unspecified, intra-abdominal lymph nodes
C82.24 Follicular lymphoma grade III, unspecified, lymph nodes of axilla and upper limb
C82.25 Follicular lymphoma grade III, unspecified, lymph nodes of inguinal region and lower limb
C82.26 Follicular lymphoma grade III, unspecified, intrapelvic lymph nodes
C82.27 Follicular lymphoma grade III, unspecified, spleen
C82.28 Follicular lymphoma grade III, unspecified, lymph nodes of multiple sites
C82.29 Follicular lymphoma grade III, unspecified, extranodal and solid organ sites
C82.31 Follicular lymphoma grade IIIa, lymph nodes of head, face, and neck
C82.32 Follicular lymphoma grade IIIa, intrathoracic lymph nodes
C82.33 Follicular lymphoma grade IIIa, intra-abdominal lymph nodes
C82.34 Follicular lymphoma grade IIIa, lymph nodes of axilla and upper limb
C82.35 Follicular lymphoma grade IIIa, lymph nodes of inguinal region and lower limb
C82.36 Follicular lymphoma grade IIIa, intrapelvic lymph nodes
C82.37 Follicular lymphoma grade IIIa, spleen
C82.38 Follicular lymphoma grade IIIa, lymph nodes of multiple sites
C82.39 Follicular lymphoma grade IIIa, extranodal and solid organ sites
C82.41 Follicular lymphoma grade IIIb, lymph nodes of head, face, and neck
C82.42 Follicular lymphoma grade IIIb, intrathoracic lymph nodes
C82.43 Follicular lymphoma grade IIIb, intra-abdominal lymph nodes
C82.44 Follicular lymphoma grade IIIb, lymph nodes of axilla and upper limb
C82.45 Follicular lymphoma grade IIIb, lymph nodes of inguinal region and lower limb
C82.46 Follicular lymphoma grade IIIb, intrapelvic lymph nodes
C82.47 Follicular lymphoma grade IIIb, spleen
C82.48 Follicular lymphoma grade IIIb, lymph nodes of multiple sites
C82.49 Follicular lymphoma grade IIIb, extranodal and solid organ sites
C82.51 Diffuse follicle center lymphoma, lymph nodes of head, face, and neck
C82.52 Diffuse follicle center lymphoma, intrathoracic lymph nodes
C82.53 Diffuse follicle center lymphoma, intra-abdominal lymph nodes
C82.54 Diffuse follicle center lymphoma, lymph nodes of axilla and upper limb
C82.55 Diffuse follicle center lymphoma, lymph nodes of inguinal region and lower limb
C82.56 Diffuse follicle center lymphoma, intrapelvic lymph nodes
C82.57 Diffuse follicle center lymphoma, spleen
C82.58 Diffuse follicle center lymphoma, lymph nodes of multiple sites
C82.59 Diffuse follicle center lymphoma, extranodal and solid organ sites
C82.61 Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck
C82.62 Cutaneous follicle center lymphoma, intrathoracic lymph nodes
C82.63 Cutaneous follicle center lymphoma, intra-abdominal lymph nodes
C82.64 Cutaneous follicle center lymphoma, lymph nodes of axilla and upper limb
C82.65 Cutaneous follicle center lymphoma, lymph nodes of inguinal region and lower limb
C82.66 Cutaneous follicle center lymphoma, intrapelvic lymph nodes
C82.67 Cutaneous follicle center lymphoma, spleen
C82.68 Cutaneous follicle center lymphoma, lymph nodes of multiple sites
C82.69 Cutaneous follicle center lymphoma, extranodal and solid organ sites
C82.81 Other types of follicular lymphoma, lymph nodes of head, face, and neck
C82.82 Other types of follicular lymphoma, intrathoracic lymph nodes
C82.83 Other types of follicular lymphoma, intra-abdominal lymph nodes
C82.84 Other types of follicular lymphoma, lymph nodes of axilla and upper limb
C82.85 Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb
C82.86 Other types of follicular lymphoma, intrapelvic lymph nodes
C82.87 Other types of follicular lymphoma, spleen
C82.88 Other types of follicular lymphoma, lymph nodes of multiple sites
C82.89 Other types of follicular lymphoma, extranodal and solid organ sites
C82.91 Follicular lymphoma, unspecified, lymph nodes of head, face, and neck
C82.92 Follicular lymphoma, unspecified, intrathoracic lymph nodes
C82.93 Follicular lymphoma, unspecified, intra-abdominal lymph nodes
C82.94 Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb
C82.95 Follicular lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C82.96 Follicular lymphoma, unspecified, intrapelvic lymph nodes
C82.97 Follicular lymphoma, unspecified, spleen
C82.98 Follicular lymphoma, unspecified, lymph nodes of multiple sites
C82.99 Follicular lymphoma, unspecified, extranodal and solid organ sites
D80.0 Hereditary hypogammaglobulinemia
D80.1 Nonfamilial hypogammaglobulinemia
D80.2 Selective deficiency of immunoglobulin A [IgA]
D80.3 Selective deficiency of immunoglobulin G [IgG] subclasses
D80.4 Selective deficiency of immunoglobulin M [IgM]
D80.5 Immunodeficiency with increased immunoglobulin M [IgM]
D80.6 Antibody deficiency with near-normal immunoglobulins or with hyperimmunoglobulinemia
D80.7 Transient hypogammaglobulinemia of infancy
D80.8 Other immunodeficiencies with predominantly antibody defects
D80.9 Immunodeficiency with predominantly antibody defects, unspecified
D89.810 Acute graft-versus-host disease
D89.811 Chronic graft-versus-host disease
D89.812 Acute on chronic graft-versus-host disease
D89.813 Graft-versus-host disease, unspecified
E20.0 Idiopathic hypoparathyroidism
E20.8 Other hypoparathyroidism
E20.9 Hypoparathyroidism, unspecified
E21.0 Primary hyperparathyroidism
E21.1 Secondary hyperparathyroidism, not elsewhere classified
E21.2 Other hyperparathyroidism
E21.3 Hyperparathyroidism, unspecified
E41 Nutritional marasmus
E43 Unspecified severe protein-calorie malnutrition
E55.0 Rickets, active
E55.9* Vitamin D deficiency, unspecified
E66.01 Morbid (severe) obesity due to excess calories
E66.09 Other obesity due to excess calories
E66.1 Drug-induced obesity
E66.2 Morbid (severe) obesity with alveolar hypoventilation
E66.8 Other obesity
E67.3 Hypervitaminosis D
E67.8 Other specified hyperalimentation
E68 Sequelae of hyperalimentation
E83.30 Disorder of phosphorus metabolism, unspecified
E83.31 Familial hypophosphatemia
E83.32 Hereditary vitamin D-dependent rickets (type 1) (type 2)
E83.39 Other disorders of phosphorus metabolism
E83.50* Unspecified disorder of calcium metabolism
E83.51 Hypocalcemia
E83.52 Hypercalcemia
E84.0 Cystic fibrosis with pulmonary manifestations
E84.11 Meconium ileus in cystic fibrosis
E84.19 Cystic fibrosis with other intestinal manifestations
E84.8 Cystic fibrosis with other manifestations
E84.9 Cystic fibrosis, unspecified
E89.2 Postprocedural hypoparathyroidism
E89.820 Postprocedural hematoma of an endocrine system organ or structure following an endocrine system procedure
E89.821 Postprocedural hematoma of an endocrine system organ or structure following other procedure
E89.822 Postprocedural seroma of an endocrine system organ or structure following an endocrine system procedure
E89.823 Postprocedural seroma of an endocrine system organ or structure following other procedure
J63.2 Berylliosis
K50.00 Crohn's disease of small intestine without complications
K50.011 Crohn's disease of small intestine with rectal bleeding
K50.012 Crohn's disease of small intestine with intestinal obstruction
K50.013 Crohn's disease of small intestine with fistula
K50.014 Crohn's disease of small intestine with abscess
K50.018 Crohn's disease of small intestine with other complication
K50.019 Crohn's disease of small intestine with unspecified complications
K50.10 Crohn's disease of large intestine without complications
K50.111 Crohn's disease of large intestine with rectal bleeding
K50.112 Crohn's disease of large intestine with intestinal obstruction
K50.113 Crohn's disease of large intestine with fistula
K50.114 Crohn's disease of large intestine with abscess
K50.118 Crohn's disease of large intestine with other complication
K50.119 Crohn's disease of large intestine with unspecified complications
K50.80 Crohn's disease of both small and large intestine without complications
K50.811 Crohn's disease of both small and large intestine with rectal bleeding
K50.812 Crohn's disease of both small and large intestine with intestinal obstruction
K50.813 Crohn's disease of both small and large intestine with fistula
K50.814 Crohn's disease of both small and large intestine with abscess
K50.818 Crohn's disease of both small and large intestine with other complication
K50.819 Crohn's disease of both small and large intestine with unspecified complications
K50.90 Crohn's disease, unspecified, without complications
K50.911 Crohn's disease, unspecified, with rectal bleeding
K50.912 Crohn's disease, unspecified, with intestinal obstruction
K50.913 Crohn's disease, unspecified, with fistula
K50.914 Crohn's disease, unspecified, with abscess
K50.918 Crohn's disease, unspecified, with other complication
K52.0 Gastroenteritis and colitis due to radiation
K70.2 Alcoholic fibrosis and sclerosis of liver
K70.30 Alcoholic cirrhosis of liver without ascites
K70.31 Alcoholic cirrhosis of liver with ascites
K74.1 Hepatic sclerosis
K74.2 Hepatic fibrosis with hepatic sclerosis
K74.3 Primary biliary cirrhosis
K74.4 Secondary biliary cirrhosis
K74.5 Biliary cirrhosis, unspecified
K74.60 Unspecified cirrhosis of liver
K74.69 Other cirrhosis of liver
K76.9 Liver disease, unspecified
K83.5 Biliary cyst
K83.8 Other specified diseases of biliary tract
K85.00 Idiopathic acute pancreatitis without necrosis or infection
K85.01 Idiopathic acute pancreatitis with uninfected necrosis
K85.02 Idiopathic acute pancreatitis with infected necrosis
K85.10 Biliary acute pancreatitis without necrosis or infection
K85.11 Biliary acute pancreatitis with uninfected necrosis
K85.12 Biliary acute pancreatitis with infected necrosis
K85.20 Alcohol induced acute pancreatitis without necrosis or infection
K85.21 Alcohol induced acute pancreatitis with uninfected necrosis
K85.22 Alcohol induced acute pancreatitis with infected necrosis
K85.30 Drug induced acute pancreatitis without necrosis or infection
K85.31 Drug induced acute pancreatitis with uninfected necrosis
K85.32 Drug induced acute pancreatitis with infected necrosis
K85.80 Other acute pancreatitis without necrosis or infection
K85.81 Other acute pancreatitis with uninfected necrosis
K85.82 Other acute pancreatitis with infected necrosis
K85.90 Acute pancreatitis without necrosis or infection, unspecified
K85.91 Acute pancreatitis with uninfected necrosis, unspecified
K85.92 Acute pancreatitis with infected necrosis, unspecified
K86.0 Alcohol-induced chronic pancreatitis
K86.1 Other chronic pancreatitis
K86.2 Cyst of pancreas
K86.3 Pseudocyst of pancreas
K86.81 Exocrine pancreatic insufficiency
K86.89 Other specified diseases of pancreas
K90.0 Celiac disease
K90.1 Tropical sprue
K90.2 Blind loop syndrome, not elsewhere classified
K90.3 Pancreatic steatorrhea
K90.41 Non-celiac gluten sensitivity
K90.49 Malabsorption due to intolerance, not elsewhere classified
K90.89 Other intestinal malabsorption
K90.9 Intestinal malabsorption, unspecified
K91.2 Postsurgical malabsorption, not elsewhere classified
L40.0 Psoriasis vulgaris
L40.1 Generalized pustular psoriasis
L40.2 Acrodermatitis continua
L40.3 Pustulosis palmaris et plantaris
L40.4 Guttate psoriasis
L40.50 Arthropathic psoriasis, unspecified
L40.51 Distal interphalangeal psoriatic arthropathy
L40.52 Psoriatic arthritis mutilans
L40.53 Psoriatic spondylitis
L40.54 Psoriatic juvenile arthropathy
L40.59 Other psoriatic arthropathy
L40.8 Other psoriasis
L40.9 Psoriasis, unspecified
M80.00XA - M80.88XS Age-related osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture - Other osteoporosis with current pathological fracture, vertebra(e), sequela
M81.0 Age-related osteoporosis without current pathological fracture
M81.6 Localized osteoporosis [Lequesne]
M81.8 Other osteoporosis without current pathological fracture
M83.0 Puerperal osteomalacia
M83.1 Senile osteomalacia
M83.2 Adult osteomalacia due to malabsorption
M83.3 Adult osteomalacia due to malnutrition
M83.4 Aluminum bone disease
M83.5 Other drug-induced osteomalacia in adults
M83.8 Other adult osteomalacia
M83.9 Adult osteomalacia, unspecified
M85.80* Other specified disorders of bone density and structure, unspecified site
M85.831* Other specified disorders of bone density and structure, right forearm
M85.832* Other specified disorders of bone density and structure, left forearm
M85.839* Other specified disorders of bone density and structure, unspecified forearm
M85.851* Other specified disorders of bone density and structure, right thigh
M85.852* Other specified disorders of bone density and structure, left thigh
M85.859* Other specified disorders of bone density and structure, unspecified thigh
M85.88* Other specified disorders of bone density and structure, other site
M85.89* Other specified disorders of bone density and structure, multiple sites
M85.9* Disorder of bone density and structure, unspecified
M89.9* Disorder of bone, unspecified
N18.3 Chronic kidney disease, stage 3 (moderate)
N18.4 Chronic kidney disease, stage 4 (severe)
N18.5 Chronic kidney disease, stage 5
N18.6 End stage renal disease
N25.81 Secondary hyperparathyroidism of renal origin
Q78.2 Osteopetrosis
Z68.30 Body mass index (BMI) 30.0-30.9, adult
Z68.31 Body mass index (BMI) 31.0-31.9, adult
Z68.32 Body mass index (BMI) 32.0-32.9, adult
Z68.33 Body mass index (BMI) 33.0-33.9, adult
Z68.34 Body mass index (BMI) 34.0-34.9, adult
Z68.35 Body mass index (BMI) 35.0-35.9, adult
Z68.36 Body mass index (BMI) 36.0-36.9, adult
Z68.37 Body mass index (BMI) 37.0-37.9, adult
Z68.38 Body mass index (BMI) 38.0-38.9, adult
Z68.39 Body mass index (BMI) 39.0-39.9, adult
Z68.41 Body mass index (BMI) 40.0-44.9, adult
Z68.42 Body mass index (BMI) 45.0-49.9, adult
Z68.43 Body mass index (BMI) 50-59.9 , adult
Z68.44 Body mass index (BMI) 60.0-69.9, adult
Z68.45 Body mass index (BMI) 70 or greater, adult
Z79.3 Long term (current) use of hormonal contraceptives
Z79.4 Long term (current) use of insulin
Z79.51 Long term (current) use of inhaled steroids
Z79.52 Long term (current) use of systemic steroids
Z79.810 Long term (current) use of selective estrogen receptor modulators (SERMs)
Z79.811 Long term (current) use of aromatase inhibitors
Z79.818 Long term (current) use of other agents affecting estrogen receptors and estrogen levels
Z79.82 Long term (current) use of aspirin
Z79.83 Long term (current) use of bisphosphonates
Z79.84 Long term (current) use of oral hypoglycemic drugs
Z79.890 Hormone replacement therapy
Z79.891 Long term (current) use of opiate analgesic
Z79.899 Other long term (current) drug therapy
Group 1 Medical Necessity ICD-10 Codes Asterisk Explanation:

E55.9* If more than one LCD-listed condition contributes to vitamin D deficiency in a given patient and/or is improved by vitamin D administration, coders should use: ICD-10 E55.9 UNSPECIFIED VITAMIN D DEFICIENCY. This code should not be used for any other indication.

E83.50* Use only for HYPERCALCIURIA

*Osteopenia should be reported using ICD-10-CM codes M85.80, M85.831-M85.839, M85.851-M85.859, M85.88, M85.89, M85.9 or M89.9

Group 2 Paragraph: 

The following ICD-10-CM codes support the medical necessity of CPT code 82652

Group 2 Codes:

ICD-10 Code Description
E55.0 Rickets, active
E55.9 Vitamin D deficiency, unspecified
E83.50* Unspecified disorder of calcium metabolism
E83.52* Hypercalcemia
M83.0 Puerperal osteomalacia
M83.1 Senile osteomalacia
M83.2 Adult osteomalacia due to malabsorption
M83.3 Adult osteomalacia due to malnutrition
M83.4 Aluminum bone disease
M83.5 Other drug-induced osteomalacia in adults
M83.8 Other adult osteomalacia
M83.9* Adult osteomalacia, unspecified
N20.0 Calculus of kidney
N20.1 Calculus of ureter
N20.2 Calculus of kidney with calculus of ureter
N20.9 Urinary calculus, unspecified
N22 Calculus of urinary tract in diseases classified elsewhere
Group 2 Medical Necessity ICD-10 Codes Asterisk Explanation:

M83.9* Use only for tumor-induced osteomalacia
E83.50* Use only for unexplained hypercalciuria
E83.52* Use only for unexplained hypercalcemia

ICD-10 Codes that DO NOT Support Medical Necessity

Group 1 Paragraph: 

All ICD-10-CM codes not listed in this policy under ICD-10-CM Codes that Support Medical Necessity above.

Group 1 Codes: N/A


 General Information

Associated Information

Documentation

    • Documentation must justify the test(s) chosen for a particular disease entity. Various component sources of 25-OH Vitamin D, such as stored D or diet-derived D, should not be billed separately.

    • If Vitamin D level is between 20 and 50 ng/dl and patient is clinically stable, documentation in the patient's medical record for repeat testing must clearly indicate the necessity of the test.

Sources of Information

N/A

Bibliography

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Revision History Information

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Associated Documents

Attachments

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Related Local Coverage Documents

Article(s)

A55852 - Response to Comments: Vitamin D Assay Testing

Related National Coverage Documents

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Public Version(s)
Updated on 02/02/2018 with effective dates 04/01/2018 - N/A


Keywords

    • Vitamin D Assay
    • Osteopenia
    • Bone Density
    • 82306
    • 82652

LCD for Vitamin D Assay Testing (L37535)

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