Vitamin D Assay Testing

Jurisdiction: JM Part B. States: North Carolina, South Carolina, Virginia, West Virginia. Type: Active LCD

This Local Coverage Determination (LCD) identifies the indications and limitations of Medicare coverage and reimbursement for Vitamin D laboratory assays in the medical management of patients. For Medicare beneficiaries, screening tests are governed by statute. Reimbursement is not allowed for routine screening for vitamin D deficiency in asymptomatic individuals and/or during general encounters. Although it is not the active form of the hormone, 25-OH vitamin D is much more commonly measured because it better reflects the sum total of vitamin D produced endogenously and absorbed from the diet than does the level of the active hormone 1,25-dihydroxy vitamin. 25-hydroxyvitamin D [25(OH)D] testing will be considered medically reasonable and necessary for individuals at risk for deficiency with the following conditions: Chronic kidney disease (CKD) stage III or greater Cystic Fibrosis (CF) Cirrhosis Crohn’s disease Gastric bypass/bariatric surgery Granuloma forming diseases Hyperalimentation Hypocalcemia Hypercalcemia Hypercalciuria Hypervitaminosis D Hypovitaminosis D Inflammatory bowel disease Long term use of medications known to lower vitamin d levels: anticonvulsants, antiretroviral therapy, glucocorticoids, antifungals, and cholestyramine Parathyroid disorders Paget’s disease of bone Obesity, if Body Mass Index (BMI) ≥ 30 kg/m2 Obstructive jaundice Osteomalacia Osteopenia Osteoporosis Osteosclerosis/petrosis Pregnant and lactating women Radiation enteritis Rickets Vitamin D deficiency on replacement therapy related to a condition listed above, to monitor the efficacy of treatment Deficiency of 1,25-dihydroxy vitamin D, which is present at much lower concentrations, does not necessarily reflect deficiency of 25-OH vitamin D and its measurement should be limited to specific clinical situations. It will be considered reasonable and necessary for patients with the following conditions: Unexplained hypercalcemia Unexplained hypercalciuria Suspected genetic childhood rickets Suspected tumor induced osteomalacia Nephrolithiasis Renal osteodystrophy Sarcoidosis Once a beneficiary has been shown to be vitamin D deficient with a serum level of If, after a 12-week period of supplementation and documentation of compliance with the prescribed supplementation, the serum level is still Thereafter, annual testing may be appropriate depending upon the indication and other mitigating factors. The documentation must support the need for annual testing. Annual testing should be rare.