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Issue Number - Name
0143-Medical Necessity for Vitamin Assay D Testing (CPT 82306, CPT 82652)
Review Type
Complex
Claim Type
Laboratory Services
Region and State
JE/JF
Date Approved
02/05/2019

Description

Vitamin D lab assay is only reimbursable under Medicare when it meets the indications under the applicable LCD and not as a routine screening according to 42 CFR 410.32(a)

Affected Codes

82306-Vitamin D, 25 HYDROXY, includes fraction(s), if performed
82652-Vitamin D, 1, 25 DIHYDROXY, includes fractions(s), if performed

Applicable Policy References

SSA, Section 1862(a)(1)(A), Section 1862(a)(7)-Exclusions from Coverage and Medicare as Secondary Payer, Section 1833(e)-Payments of Benefits
42 CFR, 410.32(a)-Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests, Conditions
CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, Section 20.4.4-Coverage of Outpatient Diagnostic Services Furnished on or After January 1, 2010
LCD, L36692-Vitamin D Assay Testing, effective 02/03/2017, revised 10/01/2018