Description

Vitamin D is a fat soluble vitamin that plays an important role in calcium regulation and bone health. Vitamin D deficiency results when an individual does not get enough vitamin D from their environment (e.g., consumed food, sun exposure) or when the liver and/or kidneys are unable to adequately convert vitamin D to its active form. Every individual has a different level of need for vitamin D, so an exact level of deficiency is often difficult to define.

Vitamin D levels are obtained through a blood test. Measuring an individual’s amount of total 25-hydroxyvitamin D is currently considered the best indicator of vitamin D status. According to the US Preventive Services Task Force (USPSTF), overall evidence on the benefits and harms of screening for vitamin D deficiency in an asymptomatic individual is lacking.

Page: 1 of 8

Vitamin D Testing

Effective Date: 07/27/2023

Revision Date: 07/27/2023

Review Date: 07/27/2023

Policy Number: HUM-0598-004
Page: 2 of 8

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Coverage Determination

Any state mandates for vitamin D testing take precedence over this medical coverage policy.

Humana members may be eligible under the Plan for vitamin D testing for the following indications:

• Condition/diagnosis associated with vitamin D deficiency that requires monitoring; OR
• Established or suspected vitamin D toxicity as evidenced by one or more of the following:
  1. Hypercalcemia; OR
  2. Hypercalciuria; OR
  3. Sarcoidosis; OR
• Repeat testing for an individual with previously documented vitamin D deficiency at least 3 months after initiation of vitamin D supplementation to monitor progress towards a therapeutic goal (serum concentration between 20 and 40 ng/mL)

29Coverage Limitations

Humana members may NOT be eligible under the Plan for vitamin D testing for general population screening or any indications other than those listed above. This is considered experimental/investigational as it is not identified as widely used and generally accepted for any other proposed use as reported in nationally recognized peer-reviewed medical literature published in the English language.

Humana members may NOT be eligible under the Plan for vitamin D testing utilizing more than one CPT code (82306, 82652, 0038U) in any combination. This is considered experimental/investigational as it is not identified as widely used and generally accepted for the proposed use as reported in nationally recognized peer- reviewed medical literature published in the English language.

Humana members may NOT be eligible under the Plan for vitamin D testing more frequently than twice in a rolling 12 month period* for any covered diagnosis other than chronic kidney disease (CKD), end-stage renal disease (ESRD) or intestinal malabsorption.

Page: 3 of 8

Policy Number: HUM-0598-004
Page: 3 of 8

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

This is considered experimental/investigational as it is not identified as widely used and generally accepted for the proposed use as reported in nationally recognized peer-reviewed medical literature published in the English language.

Humana members may NOT be eligible under the Plan for vitamin D testing to monitor supplementation therapy more frequently than twice in a rolling 12 month period*. This is considered experimental/investigational as it is not identified as widely used and generally accepted for the proposed use as reported in nationally recognized peer-reviewed medical literature published in the English language.

*A rolling 12 month period is 12 months after an event, regardless of what month the initial event took place (e.g., initial vitamin D test performed July 1, 2023, the rolling 12 month period would end June 30, 2024).

Additional information about vitamin D deficiency or toxicity may be found from the following websites:

• Background
  • National Institute of Health
  • National Library of Medicine
  • US Preventive Services Task Force (USPSTF)

Medical Alternatives

Physician consultation is advised to make an informed decision based on an individual’s health needs.

Humana may offer a disease management program for this condition. The member may call the number on his/her identification card to ask about our programs to help manage his/her care.

Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only. Do not rely on the accuracy and inclusion of specific