85385
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- The submitted medical record must support the selected ICD-10-CM code(s), and the submitted CPT/HCPCS code must accurately describe the service performed.
- The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
- When billing CPT 84999 for the listed tests, include a note identifying the specific test in the Remarks (Part A) or Narrative (Part B) area of the claim.
- All documentation must be maintained in the patient's medical record, be legible, include patient identification (e.g., complete name) and dates of service, and be made available to the contractor upon request.
Key Coverage Criteria
- For tests that currently lack specific CPT codes (functional intracellular analysis and total antioxidant function), bill using CPT 84999 and add a note identifying which test was performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
- Coverage and reasonable/necessary determinations for assays for vitamins and metabolic function are governed by LCD L34914 and claims must meet that LCD's requirements to be covered.
- Targeted single vitamin assays are covered when reasonable and necessary for diagnosis or treatment of a specific suspected vitamin deficiency documented by history and focused physical exam.
- Laboratory testing for a specific vitamin deficiency is covered when specific clinical findings suggest that deficiency (e.g., signs/symptoms or physical exam findings consistent with that vitamin deficiency).
- Vitamin testing is covered for patients with clinical states that predispose to deficiency (for example, malabsorption syndromes) when testing is targeted to the suspected deficiency.
- After a documented vitamin deficiency, follow-up testing to confirm adequate replacement is medically necessary; thereafter annual testing may be appropriate depending on the clinical indication and mitigating factors.
2 Active Policies
A56416 — Billing and Coding: Assays for Vitamins and Metabolic Function
J12
L34914 — Assays for Vitamins and Metabolic Function
J12
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.