Basics of CPT code 82306 & 82652
Vitamin D, a group of fat-soluble prohormones, is an essential Vitamin. There are two major types of Vitamin D (Vitamin D2 and Vitamin D3) which are collectively known as calciferol. They are essential for promoting calcium absorption and maintaining adequate serum calcium and phosphate concentrations to enable mineralization of bone and prevent hypocalcemic conditions. Vitamin D2 (ergocalciferol) is obtained from foods of plant origin and vitamin D3 (cholecalciferol) is obtained from foods of animal origin and ultraviolet light-stimulated conversion of 7-dehydrocholesterol in the skin. Vitamin D is stored in the human body as calcidiol (25-hydroxyvitamin D). Serum concentration of 25(OH) D is the best indicator of Vitamin D status. CPT code 82306 (Vitamin D; 25 hydroxy, includes fraction(s), if performed) is used to report for the lab test for Vitamin D.
Description of CPT code 82306 & 82652
This test may be requested as 25-OHD3, 25(OH) Calciferol, Vitamin D 25-Hydroxy, Vitamin D3 25-OH, or Calciferol 25-Hydroxy. Specimen is serum or plasma and method is high performance liquid chromatography (HPLC), competitive protein binding (CPB), or radioimmunoassay (RIA). CPT code 82306 includes fractions, if performed.
82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed
82652 1, 25 dihydroxy, includes fraction(s), if performed
The measurement of 25(OH) Vitamin D levels will be considered medically reasonable and necessary for patients with any of the following conditions:
- Chronic kidney disease stage III or greater
- Hypercalcemia
- Hypocalcemia
- Hyperparathyroidism
- Hypoparathyroidism
- Osteomalacia
- Osteoporosis
- Osteopenia
- Rickets
- Vitamin D deficiency to monitor the efficacy of replacement therapy
- Malabsorption states
- Cirrhosis (biliary, hepatic)
- Tuberculosis
- Histoplasmosis
- Coccidioidomycosis
- Berylliosis
- Follicular lymphoma
- Immunodeficiency with predominantly antibody defects
- Sarcoidosis
- Hyperalimentation
- Cystic fibrosis
- Inflammatory Bowel Disease (Crohns, Ulcerative Colitis)
- Radiation enteritis
- Liver cirrhosis
- Psoriasis
- Systemic Lupus Erythematosus
- Myositis
- Obesity
- Bariatric surgery
- Long-term use of medications known to lower vitamin D levels
Limitations
- Only one 25 OH Vitamin D level will be reimbursed in any 24 hour period.
- Patients with conditions outlined in the indications (acute and high risk conditions associated with Vitamin D deficiency) are candidates for testing. Consider repeat testing in 3-4 months after starting replacement therapy and reassessing if levels < 30 ng/mL (75 nmol/L).
- It’s not reasonable and necessary to perform more than three tests per year.
- Patients with Vitamin D deficiency that have been supplemented to normal levels are limited to one test per yea
This LCD outlines the indications for Vitamin D, 25-hydroxy (CPT code 82306). This test is appropriate for assessment of Vitamin D deficiency. Vitamin D, 1,25-dihydroxy (CPT code 82652) is primarily indicated during patient evaluations for hypercalcemia and renal failure. It should not be ordered in addition to Vitamin D, 25-hydroxy for Vitamin D deficiency testing.
Reference:
https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?
