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.