E64.3 — Sequelae of rickets
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- When a referring or ordering physician is required, the referring/ordering provider's name and NPI must be reported on the claim.
- For diagnostic tests, report the test result on the claim if known; if the result is not known at time of billing, report the symptoms that prompted the test.
- Diagnosis code(s) on the claim must best describe the patient's condition for which the Vitamin D assay was performed.
- All services and procedures performed on the same day for the same beneficiary by the same physician/provider should be billed on the same claim (use appropriate claim form and fields per CMS guidance).
Key Coverage Criteria
- Vitamin D assay testing is payable under Medicare Part B when performed in an office (POS 11), independent clinic (POS 49), Federally Qualified Health Center (POS 50), or independent laboratory (POS 81).
- Non-physician practitioners (e.g., nurse practitioners, clinical nurse specialists, physician assistants) may certify, order, and establish the plan of care for Vitamin D assay testing as authorized by State law (outpatient settings other than CORFs).
- Measurement of 25OHD is indicated for patients with psoriasis.
- Measurement of 25OHD is indicated for patients with Paget's disease of bone.
- Measurement of 25OHD is indicated for patients post-gastric bypass surgery.
- Measurement of 25OHD is indicated for patients with obesity when clinically justified.
5 Active Policies
A57484 — Billing and Coding: Vitamin D Assay Testing
J05
L34658 — Vitamin D Assay Testing
J05
AETNA-CPB-0636 — Hammertoe Repair
AETNA-CPB-0669 — Subtalar Implant for Foot Deformity
ANTHEM-MP-A050277 — ANC.00009 Cosmetic and Reconstructive Services of the Trunk, Groin, and Extremities
Related Codes
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