The Connection OnlineSM

April 2011

April 2011

New policy for routine vitamin D testing

Note from the editor (6/1/11): Applicable ICD-9-CM diagnosis codes clarified and effective date of policy changed to September 1, 2011. Refer to the June 1 newsletter article for update.

Serum testing for vitamin D levels has been receiving significant attention in the media and medical literature. We have continued to see vitamin D testing claims costs escalate over the past several years. The value of vitamin D testing in many clinical circumstances is not established in the scientific literature - especially for routine screening purposes. We are therefore implementing a new Vitamin D Testing (Laboratory #52) medical policy, effective July 1, 2011. This policy, which provides detailed rationale, finds vitamin D testing not medically necessary for routine screening purposes and will be denied as a provider write-off.

The Vitamin D testing policy applies to group and Individual products, excluding Federal Employee Program members. It also includes Regence MedAdvantage for independent laboratories and physicians, unless there is an applicable Medicare Part B national coverage determination (NCD) or a local coverage determination (LCD) specific to vitamin D testing implemented. For hospitals, Noridian® Administrative Services, LLC administers Medicare Part A in the Regence service area. They have issued a local coverage determination (LCD) specific to vitamin D testing that applies to Regence MedAdvantage members. Regence will follow the LCD when processing hospital claims for those members.

Although there is evidence that vitamin D plays an essential role in promoting bone growth and maintenance, there is considerable uncertainty with respect to both the reliability of the test itself and the clinical utility of testing for many indications. Specifically:

  • Toxic, deficient and optimal vitamin D serum levels have not been defined.
  • The serum tests are not sufficiently standardized, so there is substantial variability among the different assay types and between laboratories.
  • There is no evidence to demonstrate that testing results in better treatment plans or improved health outcomes for patients who do not have signs or symptoms of diseases or conditions specifically associated with vitamin D deficiency.

Serum testing for calcitriol (1,25[OH]2D) is considered not medically necessary for any indication because it is not considered to be a good indicator of vitamin D levels and has a very short half-life. Production in the kidney is closely regulated by a number of different factors, and a significant decrease is observed only when deficiency is severe.

We will continue to monitor and evaluate the scientific evidence regarding vitamin D testing, including the benefits of testing patients who do not have symptoms indicative of a vitamin D deficiency.

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