Z79.631 — Long term (current) use of antimetabolite agent
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The medical record must clearly document the necessity for the vitamin D test(s), including the clinical indication, and must document any repeat testing and the frequency of repeat testing.
- Medical records relating to the test must be made available to Medicare upon request.
- Providers must follow Correct Coding Initiative (CCI) guidance for correct HCPCS/CPT coding and appropriate code combinations prior to billing Medicare; documentation must support the CPT/HCPCS codes billed.
- The article provides billing/coding guidance that complements LCD L39400; use the documentation, prior authorization, and claim submission requirements specified in LCD L39400 and the local contractor's instructions.
Key Coverage Criteria
- Vitamin D assay testing is covered when the medical record documents medical necessity for the test, including the clinical reason for testing and any planned repeat testing and frequency.
- No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
- Measurement of 25‑OH Vitamin D is indicated for patients with chronic kidney disease stage III or greater.
- Measurement of 25‑OH Vitamin D is indicated for patients with cirrhosis.
- Measurement of 25‑OH Vitamin D is indicated for patients with hypocalcemia.
- Measurement of 25‑OH Vitamin D is indicated for patients with hypercalcemia.
4 Active Policies
A57718 — Billing and Coding: Vitamin D Assay Testing
A59186 — Billing and Coding: Magnesium
L36692 — Vitamin D Assay Testing
L39400 — Magnesium
Related Codes
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