New coverage policy for vitamin D testing effective May 1

Effective May 1, vitamin D testing will only be a covered benefit when the test is deemed medically necessary.

When is 25-hydroxyvitamin D a covered benefit?

Vitamin D testing may be considered medically necessary and, therefore, a covered benefit, only in patients with clinical documentation of one or more underlying diseases or conditions specifically associated with vitamin D deficiency or decreased bone density.

When is 25-hydroxyvitamin D not a covered benefit?

Vitamin D testing is considered not medically necessary and is not a covered benefit in the following situations:

  • Routine testing or general population screening
  • In individuals exhibiting no known signs or symptoms of vitamin D deficiency or intoxication
  • In the absence of an underlying disease or condition specifically associated with vitamin D deficiency and for which vitamin D treatment is recommended
  • When ordered in response to a diagnosis NOT listed.

Plan types affected

This policy only affects commercial and Medicaid plans.

Read the full Vitamin D medical policy.