Aetna®, Cigna®, UnitedHealthcare® Community Plan and other commercial insurance providers have recently published coverage policies for Vitamin D testing and, in some circumstances, may no longer cover Vitamin D testing. The newly published coverage policies describe reimbursement for Vitamin D testing including a brief overview, instructions for use, medical necessity, general background information, and ICD-10 codes which are defined by the policy as medically supportive. Individual plans may vary. As always, for the most accurate coverage policy for each patient, please contact the patient’s health plan.
TEST AFFECTED BY THE POLICY:
| Vitamin D, 25 Hydroxy | 4958 | 82306 |
| Vitamin D, 1,25 Dihydroxy | 4960 | 82652 |
| Test Name | Unit Code | CPT Code |
The ICD-10 codes listed below are the top diagnosis codes currently utilized by ordering physicians for the tests indicated above that are also listed as medically supportive under these commercial policies. If ordering these tests for diagnostic purposes that are not covered under the policies, patients may be responsible for payment. The policies specify covered ICD-10 diagnosis codes with a note that the list of codes may not be all-inclusive and that deleted codes which are not effective at the time of service may not be eligible for reimbursement.
MOST COMMON APPROPRIATE ICD-10 CODE DESCRIPTIONS:
| E21.3 | Hyperparathyroidism, unspecified | M06.9 | Rheumatoid arthritis, unspecified |
| E55.9 | Vitamin D deficiency, unspecified | M81.0 | Age-related osteoporosis without current pathological fracture |
| E83.51 | Hypocalcemia | N18.2 | Chronic kidney disease, stage 2 (mild) |
| E83.52 | Hypercalcemia | N18.3 | Chronic kidney disease, stage 3 (moderate) |
| K50.90 | Crohn’s disease, unspecified, without complications | N18.4 | Chronic kidney disease, stage 4 (severe) |
| K51.90 | Ulcerative colitis, unspecified, without complications | N18.9 | Chronic kidney disease, unspecified |
| K90.0 | Celiac disease | Z79.899 | Other long term (current) drug therapy |
| K91.2 | Postsurgical malabsorption, not elsewhere classified | Z98.84 | Bariatric surgery status |
| Code | Description | Code | Description |
|---|
Full Vitamin D coverage policies from the commercial insurers listed above can be accessed in the following links:
|
AETNA |
CIGNA |
UHC COMMUNITY PLAN |
Disclaimer: ICD-10 diagnosis codes are subject to change. Please see the insurers’ full vitamin D coverage policy for current diagnosis codes considered medically necessary