Vitamin D Assay Testing

Medicare covers measurement of 25-hydroxyvitamin D for specified clinical conditions (eg, CKD stage III+, cirrhosis, calcium disorders, malabsorption, osteomalacia, osteoporosis with supporting evidence, rickets, and to monitor replacement therapy) and measurement of 1,25-dihydroxyvitamin D for specific disorders (eg, unexplained hypercalcemia/hypercalciuria with suspected granulomatous disease or lymphoma, genetic rickets, tumor-induced osteomalacia, nephrolithiasis). Both assays are not required for every indication, testing is not for routine population screening, repeat testing is generally unnecessary for stable patients with 25-OH levels 20–50 ng/mL, and repeat levels may be reimbursed if 25-OH ≥60 ng/mL until normalized. Documentation must include relevant lab results and clinical justification (DEXA T-score, fragility fracture history, FRAX, serum calcium, or specific clinical suspicion) to support medical necessity.

"Measure 25-hydroxyvitamin D (25-OH) for patients with chronic kidney disease stage III or greater."