Procedure Codes and Description
Group 1 Paragraph: Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural (CPT) codes.
Group 1 Codes:
82306VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED
82652VITAMIN D; 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED
Coverage Indications, Limitations, and/or Medical Necessity
Vitamin D is called a "vitamin" because of its exogenous source, predominately from oily fish in the form of vitamin D 2 and vitamin D 3. It is more accurate to consider fat-soluble Vitamin D as a steroid hormone, synthesized by the skin and metabolized by the kidney to an active hormone, calcitriol. Clinical disorders related to vitamin D may arise because of altered availability of the parent vitamin D, altered conversion of vitamin D to its predominant metabolites, altered organ responsiveness to dihydroxylated metabolites and disturbances in the interactions of the vitamin D metabolites with PTH and calcitonin. Normal levels of Vitamin D range from 20 – 50 ng/dl. This LCD identifies the indications and limitations of Medicare coverage and reimbursement for the lab assay.
Indications:
Measurement of 25-OH Vitamin D, CPT 82306, level is indicated for patients with:
chronic kidney disease stage III or greater
cirrhosis
hypocalcemia
hypercalcemia
hypercalciuria
hypervitaminosis D
parathyroid disorders
malabsorption states
obstructive jaundice
osteomalacia
osteoporosis if
i. T score on DEXA scan <-2 .5="" nbsp="" or="" p="">ii. History of fragility fractures or
iii. FRAX > 3% 10-year probability of hip fracture or 20% 10-year probability of other major osteoporotic fracture or
iv. FRAX > 3% (any fracture) with T-score <-1 .5="" or="" p="">v. Initiating bisphosphanate therapy (Vit D level should be determined and managed as necessary before bisphosphonate is initiated)
osteosclerosis/petrosis
rickets
vitamin D deficiency on replacement therapy related to a condition listed above; to monitor the efficacy of treatment.
Measurement of 1, 25-OH Vitamin D, CPT 82652, level is indicated for patients with:
unexplained hypercalcemia (suspected granulomatous disease or lymphoma)
unexplained hypercalciuria (suspected granulomatous disease or lymphoma)
suspected genetic childhood rickets
suspected tumor-induced osteomalacia
nephrolithiasis or hypercalciuria
Limitations:
Testing may not be used for routine or other screening.
Both assays of vitamin D need not be performed for each of the above conditions. Often, one type is more appropriate for a certain disease state than another. The most common type of vitamin D deficiency is 25-OH vitamin D. A much smaller percentage of 1,25 dihydroxy vitamin D deficiency exists; mostly, in those with renal disease. Documentation must justify the test(s) chosen for a particular disease entity. Various component sources of 25-OH vitamin D, such as stored D or diet-derived D, should not be billed separately.
Once a beneficiary has been shown to be vitamin D deficient, further testing may be medically necessary only to ensure adequate replacement has been accomplished. If Vitamin D level is between 20 and 50 ng/dl and patient is clinically stable, repeat testing is often unnecessary; if performed, documentation most clearly indicate the necessity of the test. If level <20 dl="" ng="" or=""> 60 ng/dl, a subsequent level(s) may be reimbursed until the level is within the normal range.20>
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
012xHospital Inpatient (Medicare Part B only)
013xHospital Outpatient
014xHospital - Laboratory Services Provided to Non-patients
018xHospital - Swing Beds
022xSkilled Nursing - Inpatient (Medicare Part B only)
023xSkilled Nursing - Outpatient
085xCritical Access Hospital
Revenue Codes:
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
0300Laboratory - General Classification
0301Laboratory - Chemistry
0309Laboratory - Other Laboratory
ICD-10 Codes that Support Medical Necessity
ICD-10 CODEDESCRIPTION
E20.0Idiopathic hypoparathyroidism
E20.8Other hypoparathyroidism
E20.9Hypoparathyroidism, unspecified
E21.0Primary hyperparathyroidism
E21.1Secondary hyperparathyroidism, not elsewhere classified
E21.2Other hyperparathyroidism
E21.3Hyperparathyroidism, unspecified
E41Nutritional marasmus
E43Unspecified severe protein-calorie malnutrition
E55.0Rickets, active
E55.9*Vitamin D deficiency, unspecified
E67.3Hypervitaminosis D
E83.30Disorder of phosphorus metabolism, unspecified
E83.31Familial hypophosphatemia
E83.32Hereditary vitamin D-dependent rickets (type 1) (type 2)
E83.39Other disorders of phosphorus metabolism
E83.50*Unspecified disorder of calcium metabolism
E83.51Hypocalcemia
E83.52Hypercalcemia
E89.2Postprocedural hypoparathyroidism
E89.820Postprocedural hematoma of an endocrine system organ or structure following an endocrine system procedure
E89.821Postprocedural hematoma of an endocrine system organ or structure following other procedure
E89.822Postprocedural seroma of an endocrine system organ or structure following an endocrine system procedure
E89.823Postprocedural seroma of an endocrine system organ or structure following other procedure
K74.1Hepatic sclerosis
K74.2Hepatic fibrosis with hepatic sclerosis
K76.9Liver disease, unspecified
K90.0Celiac disease
K90.1Tropical sprue
K90.2Blind loop syndrome, not elsewhere classified
K90.3Pancreatic steatorrhea
K90.41Non-celiac gluten sensitivity
K90.49Malabsorption due to intolerance, not elsewhere classified
K90.89Other intestinal malabsorption
K90.9Intestinal malabsorption, unspecified
K91.2Postsurgical malabsorption, not elsewhere classified
M81.0Age-related osteoporosis without current pathological fracture
M81.8Other osteoporosis without current pathological fracture
M83.0Puerperal osteomalacia
M83.1Senile osteomalacia
M83.2Adult osteomalacia due to malabsorption
M83.3Adult osteomalacia due to malnutrition
M83.4Aluminum bone disease
M83.5Other drug-induced osteomalacia in adults
M83.8Other adult osteomalacia
M83.9Adult osteomalacia, unspecified
M85.80Other specified disorders of bone density and structure, unspecified site
M85.88Other specified disorders of bone density and structure, other site
N18.3Chronic kidney disease, stage 3 (moderate)
N18.4Chronic kidney disease, stage 4 (severe)
N18.5Chronic kidney disease, stage 5
N18.6End stage renal disease
N25.81Secondary hyperparathyroidism of renal origin
Q78.2Osteopetrosis
Group 1 Medical Necessity ICD-10 Codes Asterisk Explanation: E55.9* If more than one LCD-listed condition contributes to Vit. D deficiency in a given patient and/or is improved by Vit. D administration, coders should use: ICD-10 E55.9 UNSPECIFIED VITAMIN D DEFICIENCY.This code should not be used for any other indication.
E83.50* Use only for HYPERCALCIURIA
t
Group 2 Paragraph: The following ICD-10-CM codes support the medical necessity of CPT code 82652
Group 2 Codes:
Show entries for Group 2 ICD-10 Codes that Support Medical Necessity:
Search Group 2 ICD-10 Codes that Support Medical Necessity textbox:
Search By:Group 2 ICD-10 Codes that Support Medical Necessity radio button CodeGroup 2 ICD-10 Codes that Support Medical Necessity radio button DescriptionSearch Group 2 ICD-10 Codes that Support Medical Necessity Submit buttonSEARCH GROUPSearch Group 2 ICD-10 Codes that Support Medical Necessity Clear buttonCLEAR SEARCH
Group 2Codes
ICD-10 CODEDESCRIPTION
E55.0Rickets, active
E55.9Vitamin D deficiency, unspecified
E83.50*Unspecified disorder of calcium metabolism
E83.52*Hypercalcemia
M83.0Puerperal osteomalacia
M83.1Senile osteomalacia
M83.2Adult osteomalacia due to malabsorption
M83.3Adult osteomalacia due to malnutrition
M83.4Aluminum bone disease
M83.5Other drug-induced osteomalacia in adults
M83.8Other adult osteomalacia
M83.9Adult osteomalacia, unspecified
N20.0Calculus of kidney
N20.1Calculus of ureter
N20.2Calculus of kidney with calculus of ureter
N20.9Urinary calculus, unspecified
N22Calculus of urinary tract in diseases classified elsewhere
Group 2 Medical Necessity ICD-10 Codes Asterisk Explanation: M83.9* Use only for tumor-induced osteomalacia
E83.50* Use only for unexplained hypercalciuria
E83.52* Use only for unexplained hypercalcemia
Showing 1 to 17 of 17 entries in Group 2
FirstPrevCurrently Selected1NextLast
Additional ICD-10 Information
N/A-1>-2>
Group 1 Paragraph: Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural (CPT) codes.
Group 1 Codes:
82306VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED
82652VITAMIN D; 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED
Coverage Indications, Limitations, and/or Medical Necessity
Vitamin D is called a "vitamin" because of its exogenous source, predominately from oily fish in the form of vitamin D 2 and vitamin D 3. It is more accurate to consider fat-soluble Vitamin D as a steroid hormone, synthesized by the skin and metabolized by the kidney to an active hormone, calcitriol. Clinical disorders related to vitamin D may arise because of altered availability of the parent vitamin D, altered conversion of vitamin D to its predominant metabolites, altered organ responsiveness to dihydroxylated metabolites and disturbances in the interactions of the vitamin D metabolites with PTH and calcitonin. Normal levels of Vitamin D range from 20 – 50 ng/dl. This LCD identifies the indications and limitations of Medicare coverage and reimbursement for the lab assay.
Indications:
Measurement of 25-OH Vitamin D, CPT 82306, level is indicated for patients with:
chronic kidney disease stage III or greater
cirrhosis
hypocalcemia
hypercalcemia
hypercalciuria
hypervitaminosis D
parathyroid disorders
malabsorption states
obstructive jaundice
osteomalacia
osteoporosis if
i. T score on DEXA scan <-2 .5="" nbsp="" or="" p="">ii. History of fragility fractures or
iii. FRAX > 3% 10-year probability of hip fracture or 20% 10-year probability of other major osteoporotic fracture or
iv. FRAX > 3% (any fracture) with T-score <-1 .5="" or="" p="">v. Initiating bisphosphanate therapy (Vit D level should be determined and managed as necessary before bisphosphonate is initiated)
osteosclerosis/petrosis
rickets
vitamin D deficiency on replacement therapy related to a condition listed above; to monitor the efficacy of treatment.
Measurement of 1, 25-OH Vitamin D, CPT 82652, level is indicated for patients with:
unexplained hypercalcemia (suspected granulomatous disease or lymphoma)
unexplained hypercalciuria (suspected granulomatous disease or lymphoma)
suspected genetic childhood rickets
suspected tumor-induced osteomalacia
nephrolithiasis or hypercalciuria
Limitations:
Testing may not be used for routine or other screening.
Both assays of vitamin D need not be performed for each of the above conditions. Often, one type is more appropriate for a certain disease state than another. The most common type of vitamin D deficiency is 25-OH vitamin D. A much smaller percentage of 1,25 dihydroxy vitamin D deficiency exists; mostly, in those with renal disease. Documentation must justify the test(s) chosen for a particular disease entity. Various component sources of 25-OH vitamin D, such as stored D or diet-derived D, should not be billed separately.
Once a beneficiary has been shown to be vitamin D deficient, further testing may be medically necessary only to ensure adequate replacement has been accomplished. If Vitamin D level is between 20 and 50 ng/dl and patient is clinically stable, repeat testing is often unnecessary; if performed, documentation most clearly indicate the necessity of the test. If level <20 dl="" ng="" or=""> 60 ng/dl, a subsequent level(s) may be reimbursed until the level is within the normal range.20>
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
012xHospital Inpatient (Medicare Part B only)
013xHospital Outpatient
014xHospital - Laboratory Services Provided to Non-patients
018xHospital - Swing Beds
022xSkilled Nursing - Inpatient (Medicare Part B only)
023xSkilled Nursing - Outpatient
085xCritical Access Hospital
Revenue Codes:
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
0300Laboratory - General Classification
0301Laboratory - Chemistry
0309Laboratory - Other Laboratory
ICD-10 Codes that Support Medical Necessity
ICD-10 CODEDESCRIPTION
E20.0Idiopathic hypoparathyroidism
E20.8Other hypoparathyroidism
E20.9Hypoparathyroidism, unspecified
E21.0Primary hyperparathyroidism
E21.1Secondary hyperparathyroidism, not elsewhere classified
E21.2Other hyperparathyroidism
E21.3Hyperparathyroidism, unspecified
E41Nutritional marasmus
E43Unspecified severe protein-calorie malnutrition
E55.0Rickets, active
E55.9*Vitamin D deficiency, unspecified
E67.3Hypervitaminosis D
E83.30Disorder of phosphorus metabolism, unspecified
E83.31Familial hypophosphatemia
E83.32Hereditary vitamin D-dependent rickets (type 1) (type 2)
E83.39Other disorders of phosphorus metabolism
E83.50*Unspecified disorder of calcium metabolism
E83.51Hypocalcemia
E83.52Hypercalcemia
E89.2Postprocedural hypoparathyroidism
E89.820Postprocedural hematoma of an endocrine system organ or structure following an endocrine system procedure
E89.821Postprocedural hematoma of an endocrine system organ or structure following other procedure
E89.822Postprocedural seroma of an endocrine system organ or structure following an endocrine system procedure
E89.823Postprocedural seroma of an endocrine system organ or structure following other procedure
K74.1Hepatic sclerosis
K74.2Hepatic fibrosis with hepatic sclerosis
K76.9Liver disease, unspecified
K90.0Celiac disease
K90.1Tropical sprue
K90.2Blind loop syndrome, not elsewhere classified
K90.3Pancreatic steatorrhea
K90.41Non-celiac gluten sensitivity
K90.49Malabsorption due to intolerance, not elsewhere classified
K90.89Other intestinal malabsorption
K90.9Intestinal malabsorption, unspecified
K91.2Postsurgical malabsorption, not elsewhere classified
M81.0Age-related osteoporosis without current pathological fracture
M81.8Other osteoporosis without current pathological fracture
M83.0Puerperal osteomalacia
M83.1Senile osteomalacia
M83.2Adult osteomalacia due to malabsorption
M83.3Adult osteomalacia due to malnutrition
M83.4Aluminum bone disease
M83.5Other drug-induced osteomalacia in adults
M83.8Other adult osteomalacia
M83.9Adult osteomalacia, unspecified
M85.80Other specified disorders of bone density and structure, unspecified site
M85.88Other specified disorders of bone density and structure, other site
N18.3Chronic kidney disease, stage 3 (moderate)
N18.4Chronic kidney disease, stage 4 (severe)
N18.5Chronic kidney disease, stage 5
N18.6End stage renal disease
N25.81Secondary hyperparathyroidism of renal origin
Q78.2Osteopetrosis
Group 1 Medical Necessity ICD-10 Codes Asterisk Explanation: E55.9* If more than one LCD-listed condition contributes to Vit. D deficiency in a given patient and/or is improved by Vit. D administration, coders should use: ICD-10 E55.9 UNSPECIFIED VITAMIN D DEFICIENCY.This code should not be used for any other indication.
E83.50* Use only for HYPERCALCIURIA
t
Group 2 Paragraph: The following ICD-10-CM codes support the medical necessity of CPT code 82652
Group 2 Codes:
Show entries for Group 2 ICD-10 Codes that Support Medical Necessity:
Search Group 2 ICD-10 Codes that Support Medical Necessity textbox:
Search By:Group 2 ICD-10 Codes that Support Medical Necessity radio button CodeGroup 2 ICD-10 Codes that Support Medical Necessity radio button DescriptionSearch Group 2 ICD-10 Codes that Support Medical Necessity Submit buttonSEARCH GROUPSearch Group 2 ICD-10 Codes that Support Medical Necessity Clear buttonCLEAR SEARCH
Group 2Codes
ICD-10 CODEDESCRIPTION
E55.0Rickets, active
E55.9Vitamin D deficiency, unspecified
E83.50*Unspecified disorder of calcium metabolism
E83.52*Hypercalcemia
M83.0Puerperal osteomalacia
M83.1Senile osteomalacia
M83.2Adult osteomalacia due to malabsorption
M83.3Adult osteomalacia due to malnutrition
M83.4Aluminum bone disease
M83.5Other drug-induced osteomalacia in adults
M83.8Other adult osteomalacia
M83.9Adult osteomalacia, unspecified
N20.0Calculus of kidney
N20.1Calculus of ureter
N20.2Calculus of kidney with calculus of ureter
N20.9Urinary calculus, unspecified
N22Calculus of urinary tract in diseases classified elsewhere
Group 2 Medical Necessity ICD-10 Codes Asterisk Explanation: M83.9* Use only for tumor-induced osteomalacia
E83.50* Use only for unexplained hypercalciuria
E83.52* Use only for unexplained hypercalcemia
Showing 1 to 17 of 17 entries in Group 2
FirstPrevCurrently Selected1NextLast
Additional ICD-10 Information
N/A-1>-2>