SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Vitamin D Assay Testing

A57484

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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To see the currently-in-effect version of this document, go to the section.

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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57484
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Vitamin D Assay Testing
Article Type
Billing and Coding
Original Effective Date
10/31/2019
Revision Effective Date
10/01/2022
Revision Ending Date
09/30/2023
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

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.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of Social Security Act, Section 1861 Act provides for payment of clinical laboratory services under Medicare Part B. Clinical laboratory services involve the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the diagnosis, prevention, or treatment of a disease or assessment of a medical condition.

Title XVIII of Social Security Act, Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of Social Security Act, Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

42 CFR part 493, laboratory services must meet all applicable requirements of the Clinical Laboratory Improvement Amendments of 1988 (CLIA), as set forth. Section 1862(a)(1)(A) provides that Medicare payment may not be made for services that are not reasonable and necessary.

42 CFR 410.32(a), clinical laboratory services must be ordered and used promptly by the physician who is treating the beneficiary.

42 CFR 410.32(a) (3), or by a qualified nonphysician practitioner.

CMS Pub 100-02, Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Care Services, §80.1 – Clinical Laboratory Services and 80.6 – Requirements for Ordering and Following Orders for Diagnostic Tests.

CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 1- General Billing Requirements, Sections 60 – Provider Billing of Non-covered Charges on Institutional Claims – 60.1.1 - Basic Payment Liability Conditions.

CMS Pub 100-04, Medicare Claims Processing Manual, Chapter 25 – Completing and Processing the Form CMS-1450 Data Set, Section 75.5 – From Locators 43-81, FL-67 Principal Diagnosis Codes.

CMS Transmittal No, 857, effective date October 3, 2018 Change Request 10901 Local Coverage Determinations (LCDs) Implementation date January 8, 2019.

Italicized font - represents CMS national language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national language/wording.

Article Guidance

Article Text

The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD Vitamin D Assay Testing.

A. General Guidelines for claims submitted to MAC A/B contractors:

  1. Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare.
  2. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
  3. A claim submitted without a valid diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act.
    The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise, the symptoms prompting the performance of the test should be reported.
  4. For outpatient settings other than CORFs, references to "physicians" throughout this policy include non-physicians, such as nurse practitioners, clinical nurse specialists and physician assistants. Such non-physician practitioners, with certain exceptions, may certify, order, and establish the plan of care for Vitamin D Assay Testing services as authorized by State law.

B. Billing Guidelines:
Bill type codes only apply to providers billing these services to Part A. Bill type codes do not apply to physicians, other professionals, and suppliers who bill these services to Part B. (See CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 25 – Completing and Processing the Form CMS-1450 Data Set, Section 75.5 – From Locators 43-81, FL-67 Principal Diagnosis Codes, for additional instructions.)

  1. All services/procedures performed on the same day for the same beneficiary by the physician/provider should be billed on the same claim.
  2. Claims for Vitamin D Assay Testing services are payable under Medicare Part B in the following places of service: office (11), independent clinic (49), Federally Qualified health Center (50) and independent lab (81).

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

(2 Codes) >> Includes VITAMIN D
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
82306 VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED
82652 VITAMIN D; 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(801 Codes) >> Includes VITAMIN D
Group 1 Paragraph

Note: ICD-10 codes must be coded to the highest level of specificity. For Codes in the table below that require a 7th character, letter A initial encounter, D subsequent encounter or S sequel may be used.

CPT code: 82306

Group 1 Codes
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
A17.9 Tuberculosis of nervous system, unspecified
A18.01 Tuberculosis of spine
A18.02 Tuberculous arthritis of other joints
A18.03 Tuberculosis of other bones
A18.09 Other musculoskeletal tuberculosis
A18.10 Tuberculosis of genitourinary system, unspecified
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
A18.50 Tuberculosis of eye, unspecified
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
A19.8 Other miliary tuberculosis
B38.0 - B38.89 Acute pulmonary coccidioidomycosis - Other forms of coccidioidomycosis
B39.0 - B39.5 Acute pulmonary histoplasmosis capsulati - Histoplasmosis duboisii
C22.0 Liver cell carcinoma
C22.1 Intrahepatic bile duct carcinoma
C22.2 Hepatoblastoma
C22.3 Angiosarcoma of liver
C22.4 Other sarcomas of liver
C22.7 Other specified carcinomas of liver
C22.8 Malignant neoplasm of liver, primary, unspecified as to type
C22.9 Malignant neoplasm of liver, not specified as primary or secondary
C23 Malignant neoplasm of gallbladder
C24.0 Malignant neoplasm of extrahepatic bile duct
C24.1 Malignant neoplasm of ampulla of Vater
C24.8 Malignant neoplasm of overlapping sites of biliary tract
C24.9 Malignant neoplasm of biliary tract, unspecified
C25.0 Malignant neoplasm of head of pancreas
C25.1 Malignant neoplasm of body of pancreas
C25.2 Malignant neoplasm of tail of pancreas
C25.3 Malignant neoplasm of pancreatic duct
C25.4 Malignant neoplasm of endocrine pancreas
C25.7 Malignant neoplasm of other parts of pancreas
C25.8 Malignant neoplasm of overlapping sites of pancreas
C25.9 Malignant neoplasm of pancreas, unspecified
C26.0 Malignant neoplasm of intestinal tract, part unspecified
C26.1 Malignant neoplasm of spleen
C26.9 Malignant neoplasm of ill-defined sites within the digestive system
C82.00 - C82.99 Follicular lymphoma grade I, unspecified site - Follicular lymphoma, unspecified, extranodal and solid organ sites
D13.0 Benign neoplasm of esophagus
D13.1 Benign neoplasm of stomach
D13.2 Benign neoplasm of duodenum
D13.30 Benign neoplasm of unspecified part of small intestine
D13.39 Benign neoplasm of other parts of small intestine
D13.4 Benign neoplasm of liver
D13.5 Benign neoplasm of extrahepatic bile ducts
D13.6 Benign neoplasm of pancreas
D13.7 Benign neoplasm of endocrine pancreas
D13.9 Benign neoplasm of ill-defined sites within the digestive system
D86.0 Sarcoidosis of lung
D86.1 Sarcoidosis of lymph nodes
D86.2 Sarcoidosis of lung with sarcoidosis of lymph nodes
D86.3 Sarcoidosis of skin
D86.81 Sarcoid meningitis
D86.82 Multiple cranial nerve palsies in sarcoidosis
D86.83 Sarcoid iridocyclitis
D86.84 Sarcoid pyelonephritis
D86.85 Sarcoid myocarditis
D86.86 Sarcoid arthropathy
D86.87 Sarcoid myositis
D86.89 Sarcoidosis of other sites
E20.0 Idiopathic hypoparathyroidism
E20.8 Other hypoparathyroidism
E21.0 Primary hyperparathyroidism
E21.1 Secondary hyperparathyroidism, not elsewhere classified
E21.2 Other hyperparathyroidism
E21.4 Other specified disorders of parathyroid gland
E21.5 Disorder of parathyroid gland, unspecified
E55.0 Rickets, active
E55.9 Vitamin D deficiency, unspecified
E64.3 Sequelae of rickets
E67.2 Megavitamin-B6 syndrome
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
E83.51 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
G73.7 Myopathy in diseases classified elsewhere
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
K50.919 Crohn's disease, unspecified, with unspecified complications
K51.00 Ulcerative (chronic) pancolitis without complications
K51.011 Ulcerative (chronic) pancolitis with rectal bleeding
K51.012 Ulcerative (chronic) pancolitis with intestinal obstruction
K51.013 Ulcerative (chronic) pancolitis with fistula
K51.014 Ulcerative (chronic) pancolitis with abscess
K51.018 Ulcerative (chronic) pancolitis with other complication
K51.019 Ulcerative (chronic) pancolitis with unspecified complications
K51.20 Ulcerative (chronic) proctitis without complications
K51.211 Ulcerative (chronic) proctitis with rectal bleeding
K51.212 Ulcerative (chronic) proctitis with intestinal obstruction
K51.213 Ulcerative (chronic) proctitis with fistula
K51.214 Ulcerative (chronic) proctitis with abscess
K51.218 Ulcerative (chronic) proctitis with other complication
K51.219 Ulcerative (chronic) proctitis with unspecified complications
K51.30 Ulcerative (chronic) rectosigmoiditis without complications
K51.311 Ulcerative (chronic) rectosigmoiditis with rectal bleeding
K51.312 Ulcerative (chronic) rectosigmoiditis with intestinal obstruction
K51.313 Ulcerative (chronic) rectosigmoiditis with fistula
K51.314 Ulcerative (chronic) rectosigmoiditis with abscess
K51.318 Ulcerative (chronic) rectosigmoiditis with other complication
K51.319 Ulcerative (chronic) rectosigmoiditis with unspecified complications
K51.40 Inflammatory polyps of colon without complications
K51.411 Inflammatory polyps of colon with rectal bleeding
K51.412 Inflammatory polyps of colon with intestinal obstruction
K51.413 Inflammatory polyps of colon with fistula
K51.414 Inflammatory polyps of colon with abscess
K51.418 Inflammatory polyps of colon with other complication
K51.419 Inflammatory polyps of colon with unspecified complications
K51.50 Left sided colitis without complications
K51.511 Left sided colitis with rectal bleeding
K51.512 Left sided colitis with intestinal obstruction
K51.513 Left sided colitis with fistula
K51.514 Left sided colitis with abscess
K51.518 Left sided colitis with other complication
K51.519 Left sided colitis with unspecified complications
K51.80 Other ulcerative colitis without complications
K51.811 Other ulcerative colitis with rectal bleeding
K51.812 Other ulcerative colitis with intestinal obstruction
K51.813 Other ulcerative colitis with fistula
K51.814 Other ulcerative colitis with abscess
K51.818 Other ulcerative colitis with other complication
K51.819 Other ulcerative colitis with unspecified complications
K51.90 Ulcerative colitis, unspecified, without complications
K51.911 Ulcerative colitis, unspecified with rectal bleeding
K51.912 Ulcerative colitis, unspecified with intestinal obstruction
K51.913 Ulcerative colitis, unspecified with fistula
K51.914 Ulcerative colitis, unspecified with abscess
K51.918 Ulcerative colitis, unspecified with other complication
K51.919 Ulcerative colitis, unspecified with unspecified complications
K70.2 Alcoholic fibrosis and sclerosis of liver
K70.30 Alcoholic cirrhosis of liver without ascites
K70.31 Alcoholic cirrhosis of liver with ascites
K74.00 Hepatic fibrosis, unspecified
K74.01 Hepatic fibrosis, early fibrosis
K74.02 Hepatic fibrosis, advanced fibrosis
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
K75.81 Nonalcoholic steatohepatitis (NASH)
K76.0 Fatty (change of) liver, not elsewhere classified
K76.82 Hepatic encephalopathy
K76.89 Other specified diseases of liver
K80.01 Calculus of gallbladder with acute cholecystitis with obstruction
K80.11 Calculus of gallbladder with chronic cholecystitis with obstruction
K80.13 Calculus of gallbladder with acute and chronic cholecystitis with obstruction
K80.19 Calculus of gallbladder with other cholecystitis with obstruction
K80.21 Calculus of gallbladder without cholecystitis with obstruction
K80.31 Calculus of bile duct with cholangitis, unspecified, with obstruction
K80.33 Calculus of bile duct with acute cholangitis with obstruction
K80.35 Calculus of bile duct with chronic cholangitis with obstruction
K80.37 Calculus of bile duct with acute and chronic cholangitis with obstruction
K80.41 Calculus of bile duct with cholecystitis, unspecified, with obstruction
K80.43 Calculus of bile duct with acute cholecystitis with obstruction
K80.45 Calculus of bile duct with chronic cholecystitis with obstruction
K80.47 Calculus of bile duct with acute and chronic cholecystitis with obstruction
K80.51 Calculus of bile duct without cholangitis or cholecystitis with obstruction
K80.61 Calculus of gallbladder and bile duct with cholecystitis, unspecified, with obstruction
K80.63 Calculus of gallbladder and bile duct with acute cholecystitis with obstruction
K80.65 Calculus of gallbladder and bile duct with chronic cholecystitis with obstruction
K80.67 Calculus of gallbladder and bile duct with acute and chronic cholecystitis with obstruction
K80.71 Calculus of gallbladder and bile duct without cholecystitis with obstruction
K80.81 Other cholelithiasis with obstruction
K82.0 Obstruction of gallbladder
K82.8 Other specified diseases of gallbladder
K82.9 Disease of gallbladder, unspecified
K82.A1 Gangrene of gallbladder in cholecystitis
K82.A2 Perforation of gallbladder in cholecystitis
K83.01 Primary sclerosing cholangitis
K83.09 Other cholangitis
K83.1 Obstruction of bile duct
K83.2 Perforation of bile duct
K83.3 Fistula of bile duct
K83.4 Spasm of sphincter of Oddi
K83.5 Biliary cyst
K83.8 Other specified diseases of biliary tract
K83.9 Disease of biliary tract, unspecified
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
K86.2 Cyst of pancreas
K86.3 Pseudocyst of pancreas
K86.81 Exocrine pancreatic insufficiency
K86.89 Other specified diseases of pancreas
K86.9 Disease of pancreas, unspecified
K87 Disorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere
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
L40.8 Other psoriasis
L40.9 Psoriasis, unspecified
L90.0 Lichen sclerosus et atrophicus
L94.0 Localized scleroderma [morphea]
L94.1 Linear scleroderma
L94.3 Sclerodactyly
M32.0 Drug-induced systemic lupus erythematosus
M32.10 Systemic lupus erythematosus, organ or system involvement unspecified
M32.11 Endocarditis in systemic lupus erythematosus
M32.12 Pericarditis in systemic lupus erythematosus
M32.13 Lung involvement in systemic lupus erythematosus
M32.14 Glomerular disease in systemic lupus erythematosus
M32.15 Tubulo-interstitial nephropathy in systemic lupus erythematosus
M32.19 Other organ or system involvement in systemic lupus erythematosus
M32.8 Other forms of systemic lupus erythematosus
M33.01 Juvenile dermatomyositis with respiratory involvement
M33.02 Juvenile dermatomyositis with myopathy
M33.03 Juvenile dermatomyositis without myopathy
M33.09 Juvenile dermatomyositis with other organ involvement
M33.11 Other dermatomyositis with respiratory involvement
M33.12 Other dermatomyositis with myopathy
M33.13 Other dermatomyositis without myopathy
M33.19 Other dermatomyositis with other organ involvement
M33.91 Dermatopolymyositis, unspecified with respiratory involvement
M33.92 Dermatopolymyositis, unspecified with myopathy
M33.93 Dermatopolymyositis, unspecified without myopathy
M33.99 Dermatopolymyositis, unspecified with other organ involvement
M36.0 Dermato(poly)myositis in neoplastic disease
M60.811 Other myositis, right shoulder
M60.812 Other myositis, left shoulder
M60.821 Other myositis, right upper arm
M60.822 Other myositis, left upper arm
M60.831 Other myositis, right forearm
M60.832 Other myositis, left forearm
M60.841 Other myositis, right hand
M60.842 Other myositis, left hand
M60.851 Other myositis, right thigh
M60.852 Other myositis, left thigh
M60.861 Other myositis, right lower leg
M60.862 Other myositis, left lower leg
M60.871 Other myositis, right ankle and foot
M60.872 Other myositis, left ankle and foot
M60.88 Other myositis, other site
M60.89 Other myositis, multiple sites
M79.10 Myalgia, unspecified site
M79.11 Myalgia of mastication muscle
M79.12 Myalgia of auxiliary muscles, head and neck
M79.18 Myalgia, other site
M79.7 Fibromyalgia
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
M80.8AXA - M80.8AXS Other osteoporosis with current pathological fracture, other site, initial encounter for fracture - Other osteoporosis with current pathological fracture, other site, 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
M85.811 Other specified disorders of bone density and structure, right shoulder
M85.812 Other specified disorders of bone density and structure, left shoulder
M85.821 Other specified disorders of bone density and structure, right upper arm
M85.822 Other specified disorders of bone density and structure, left upper arm
M85.831 Other specified disorders of bone density and structure, right forearm
M85.832 Other specified disorders of bone density and structure, left forearm
M85.841 Other specified disorders of bone density and structure, right hand
M85.842 Other specified disorders of bone density and structure, left hand
M85.851 Other specified disorders of bone density and structure, right thigh
M85.852 Other specified disorders of bone density and structure, left thigh
M85.861 Other specified disorders of bone density and structure, right lower leg
M85.862 Other specified disorders of bone density and structure, left lower leg
M85.871 Other specified disorders of bone density and structure, right ankle and foot
M85.872 Other specified disorders of bone density and structure, left ankle and foot
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
M88.0 Osteitis deformans of skull
M88.1 Osteitis deformans of vertebrae
M88.811 Osteitis deformans of right shoulder
M88.812 Osteitis deformans of left shoulder
M88.821 Osteitis deformans of right upper arm
M88.822 Osteitis deformans of left upper arm
M88.831 Osteitis deformans of right forearm
M88.832 Osteitis deformans of left forearm
M88.841 Osteitis deformans of right hand
M88.842 Osteitis deformans of left hand
M88.851 Osteitis deformans of right thigh
M88.852 Osteitis deformans of left thigh
M88.861 Osteitis deformans of right lower leg
M88.862 Osteitis deformans of left lower leg
M88.871 Osteitis deformans of right ankle and foot
M88.872 Osteitis deformans of left ankle and foot
M88.88 Osteitis deformans of other bones
M88.89 Osteitis deformans of multiple sites
M88.9 Osteitis deformans of unspecified bone
M89.9 Disorder of bone, unspecified
M94.9 Disorder of cartilage, unspecified
N18.30 Chronic kidney disease, stage 3 unspecified
N18.31 Chronic kidney disease, stage 3a
N18.32 Chronic kidney disease, stage 3b
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
O99.841 Bariatric surgery status complicating pregnancy, first trimester
O99.842 Bariatric surgery status complicating pregnancy, second trimester
O99.843 Bariatric surgery status complicating pregnancy, third trimester
O99.844 Bariatric surgery status complicating childbirth
O99.845 Bariatric surgery status complicating the puerperium
Q78.0 Osteogenesis imperfecta
Q78.2 Osteopetrosis
T30.0 Burn of unspecified body region, unspecified degree
T30.4 Corrosion of unspecified body region, unspecified degree
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] 50.0-59.9, 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
Z79.51 Long term (current) use of inhaled steroids
Z79.52 Long term (current) use of systemic steroids
Z79.85 Long-term (current) use of injectable non-insulin antidiabetic drugs
Z79.891 Long term (current) use of opiate analgesic
Z79.899 Other long term (current) drug therapy
Z98.0 Intestinal bypass and anastomosis status
Z98.84 Bariatric surgery status

Group 2

(123 Codes) >> Includes VITAMIN D
Group 2 Paragraph

CPT code: 82652

Group 2 Codes
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
A17.9 Tuberculosis of nervous system, unspecified
A18.01 Tuberculosis of spine
A18.02 Tuberculous arthritis of other joints
A18.03 Tuberculosis of other bones
A18.09 Other musculoskeletal tuberculosis
A18.10 Tuberculosis of genitourinary system, unspecified
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
A18.50 Tuberculosis of eye, unspecified
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
A19.9 Miliary tuberculosis, unspecified
C83.80 Other non-follicular lymphoma, unspecified site
C83.81 Other non-follicular lymphoma, lymph nodes of head, face, and neck
C83.82 Other non-follicular lymphoma, intrathoracic lymph nodes
C83.83 Other non-follicular lymphoma, intra-abdominal lymph nodes
C83.84 Other non-follicular lymphoma, lymph nodes of axilla and upper limb
C83.85 Other non-follicular lymphoma, lymph nodes of inguinal region and lower limb
C83.86 Other non-follicular lymphoma, intrapelvic lymph nodes
C83.87 Other non-follicular lymphoma, spleen
C83.88 Other non-follicular lymphoma, lymph nodes of multiple sites
C83.89 Other non-follicular lymphoma, extranodal and solid organ sites
C84.00 Mycosis fungoides, unspecified site
C84.01 Mycosis fungoides, lymph nodes of head, face, and neck
C84.02 Mycosis fungoides, intrathoracic lymph nodes
C84.03 Mycosis fungoides, intra-abdominal lymph nodes
C84.04 Mycosis fungoides, lymph nodes of axilla and upper limb
C84.05 Mycosis fungoides, lymph nodes of inguinal region and lower limb
C84.06 Mycosis fungoides, intrapelvic lymph nodes
C84.07 Mycosis fungoides, spleen
C84.08 Mycosis fungoides, lymph nodes of multiple sites
C84.09 Mycosis fungoides, extranodal and solid organ sites
C84.10 Sezary disease, unspecified site
C84.12 Sezary disease, intrathoracic lymph nodes
C84.13 Sezary disease, intra-abdominal lymph nodes
C84.14 Sezary disease, lymph nodes of axilla and upper limb
C84.15 Sezary disease, lymph nodes of inguinal region and lower limb
C84.16 Sezary disease, intrapelvic lymph nodes
C84.17 Sezary disease, spleen
C84.18 Sezary disease, lymph nodes of multiple sites
C84.19 Sezary disease, extranodal and solid organ sites
C88.4 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma]
D86.0 Sarcoidosis of lung
D86.1 Sarcoidosis of lymph nodes
D86.2 Sarcoidosis of lung with sarcoidosis of lymph nodes
D86.3 Sarcoidosis of skin
D86.81 Sarcoid meningitis
D86.82 Multiple cranial nerve palsies in sarcoidosis
D86.83 Sarcoid iridocyclitis
D86.84 Sarcoid pyelonephritis
D86.85 Sarcoid myocarditis
D86.86 Sarcoid arthropathy
D86.87 Sarcoid myositis
D86.89 Sarcoidosis of other sites
E20.0 Idiopathic hypoparathyroidism
E20.8 Other hypoparathyroidism
E21.0 Primary hyperparathyroidism
E21.1 Secondary hyperparathyroidism, not elsewhere classified
E21.2 Other hyperparathyroidism
E21.4 Other specified disorders of parathyroid gland
E21.5 Disorder of parathyroid gland, unspecified
E55.0 Rickets, active
E55.9 Vitamin D deficiency, unspecified
E64.3 Sequelae of rickets
E67.2 Megavitamin-B6 syndrome
E67.8 Other specified hyperalimentation
E68 Sequelae of hyperalimentation
E89.2 Postprocedural hypoparathyroidism
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
N18.30 Chronic kidney disease, stage 3 unspecified
N18.31 Chronic kidney disease, stage 3a
N18.32 Chronic kidney disease, stage 3b
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
Q78.0 Osteogenesis imperfecta
Q78.2 Osteopetrosis
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
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Group 1 Codes
Code Description
XX000 Not Applicable
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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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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 article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
999x Not Applicable
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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 article, 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 article should be assumed to apply equally to all Revenue Codes.

Code Description
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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2022 R3

Posted 09/29/2022: ICD-10-CM Code Updates: Under ICD-10 Codes that Support Medical Necessity, added K76.82 and Z79.85 to the Group 1 Codes. These updates are effective 10/01/2022.

10/01/2021 R2

09/30/2021 ICD-10 CM Code Updates: Z68.30 and Z68.41 in Group 1 codes had description changes. Review completed 09/03/2021.

10/01/2020 R1

10/01/2020 ICD-10 CM Code annual update completed. Group 1 deleted K74.0 and N18.3. Group 1 added K74.00, K74.01, K74.02, M80.8AXA, M80.8AXD, M80.8AXG, M80.8AXK, M80.8AXP, M80.8AXS as a new range, M80.0AXA, M80.0AXD, M80.0AXG, M80.0AXK, M80.0AXP, M80.0AXS added to current range M80.00XA-M80.88XS, N18.30, N18.31 and N18.32. Group 1 revised descriptions: Z68.30-Z68.45. Group 2 deleted N18.3. Group 2 added N18.30, N18.31 and N18.32.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34658 - Vitamin D Assay Testing
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
11/20/2023 10/01/2023 - N/A Currently in Effect View
09/19/2023 10/01/2023 - N/A Superseded View
09/20/2022 10/01/2022 - 09/30/2023 Superseded You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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