Vitamin D Assay Testing

Medicare covers 25-hydroxyvitamin D testing when medically necessary for beneficiaries at risk for deficiency (e.g., CKD stage III+, malabsorption, certain bone, liver, or endocrine disorders, obesity with BMI ≥30, pregnancy/lactation, long-term vitamin-D–lowering medications, and to monitor replacement therapy). Measurement of 1,25-dihydroxyvitamin D is limited to specific clinical scenarios (unexplained hypercalcemia/hypercalciuria, suspected genetic rickets, tumor-induced osteomalacia, nephrolithiasis, renal osteodystrophy, sarcoidosis). Routine screening of asymptomatic individuals is not reimbursed; re-testing is recommended after a 12-week supplementation period with documented compliance, and annual testing thereafter should be rare and must be justified by documentation. Note: the policy text omits numeric serum thresholds for deficiency and retesting and these omissions require manual clarification.

"25-hydroxyvitamin D [25(OH)D] testing is medically reasonable and necessary for beneficiaries with chronic kidney disease (CKD) stage III or greater."