Vitamin D Assay Testing

Jurisdiction: JK MAC Part B. States: Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont. Type: Active LCD

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 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 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 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 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/ml and patient is clinically stable, repeat testing is often unnecessary; if performed, documentation must clearly indicate the necessity of the test. If level 60 ng/ml 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.