Unlocking Vitamin Assays with CPT 82306: A Guide for Medicare Billing

CPT 82180 82306 82607: Assays Unveiling Vitamins and Metabolic Harmony

ICD CODE by Medicalbilling4u

Procedure Code 82306: Group 1 Codes

82306 VITAMIN D 25 HYDROXY - INCLUDES FRACTIONS IF PERFORMED

82652 VITAMIN D 1 25 DIHYDROXY - INCLUDES FRACTIONS IF PERFORMED

LCD Description:

Vitamin D, a hormone synthesized by the skin and metabolized by the kidney to calcitriol, may pose risks of hypercalcemia in excess. Conversely, deficiency may give rise to diverse disorders. This LCD meticulously delineates Medicare's coverage and reimbursement nuances for these services.

ICD10 DESCRIPTION:

  • E55.9 Vitamin D deficiency unspecified
  • E20.0 Idiopathic hypoparathyroidism
  • E20.8 Other hypoparathyroidism, unspecified
  • E20.9 E21.0 Primary hyperparathyroidism
  • E21.1 E21.2 Other hyperparathyroidism, unspecified
  • E21.3 Rickets active
  • E55.0 Vitamin D deficiency unspecified

Medicare, viewing vitamin assay panels as screening procedures, deems them non-covered. Similarly, assays encompassing multiple tests for vitamins, minerals, antioxidants, and metabolic functions are deemed unnecessary. Reimbursement aligns with clinical necessity for illness diagnosis or treatment.

Diagnostic evaluations should pinpoint specific suspected vitamin deficiencies rather than pursuing generalized screening. Nutritional origin underscores most deficiencies, correctable through vitamin supplementation. Clinical findings guide testing, prompting evidence-based assessment for deficiencies.

Limitations For Medicare Beneficiaries:

Screening tests adhere to statutory guidelines, limiting vitamin or micronutrient testing for routine screening. Once vitamin deficiency is confirmed, further testing ensures adequate replacement, with subsequent annual testing contingent on indications and mitigating factors.

Assays of selenium (84255), functional intracellular analysis (84999), and total antioxidant function (84999) fall outside covered services. Unspecified vitamin testing (84591) remains uncovered, given clinically specific assays for relevant vitamins.

Pertinent Laboratory Tests (excluding non-covered):

  • 25-OH Vitamin D-3
  • Carnitine
  • Vitamin B-12
  • Folic Acid
  • Serum Homocystine
  • Vitamin B-6, B-2, B-1
  • Vitamin E
  • Fibrinogen
  • High-Sensitivity C-Reactive Protein
  • Lipoprotein-associated phospholipase A2 (Lp-PLA2)
  • Vitamin A, K
  • Ascorbic acid

Additional Inclusion with Limited Coverage:

Vitamin D (not otherwise specified)

Notice:

This LCD outlines diagnostic limitations supporting automated denials. Services must align with Medicare's indications, limitations, and general medical necessity criteria.

Billing and Coding Guidelines:

Bill Type Codes: 12X, 13X, 14X, 18X, 21X, 22X, 23X, 71X, 72X, 75X, 77X, 83X, 85X

Revenue Codes: 030X

CPT/HCPCS Codes:

  • 82180: Assay of ascorbic acid
  • 82306: Vitamin D 25-hydroxy (includes fractions if performed)
  • 82379: Carnitine
  • 82607: Cyanocobalamin (Vitamin B-12)
  • 82652: Vitamin D 1,25-dihydroxy (includes fractions if performed)
  • 82746: Folic Acid
  • 83090: Homocysteine
  • 83698: Assay lipoprotein pla2
  • 84207: Pyridoxal phosphate (Vitamin B-6)
  • 84252: Riboflavin (Vitamin B-2)
  • 84425: Thiamin (Vitamin B-1)
  • 84446: Tocopherol
  • 84590: Assay of Vitamin A
  • 84591: Assay of NOS vitamin
  • 84597: Assay of Vitamin K
  • 85385: Fibrinogen antigen
  • 86141: C-reactive protein hs
  • 86352: Cell function assay w/stim
  • 86353: Lymphocyte transformation mitogen phytomitogen or antigen-induced blastogenesis

ALL codes require CL IA certification and QW Modifier.

Vitamin D Assays (CPT code 82306):

Vitamin D is a crucial hormone synthesized by the skin, metabolized by the kidney into calcitriol. Excessive vitamin D may lead to hypercalcemia, while deficiency can cause various disorders. LCD provides insight into Medicare's coverage and reimbursement specifics for Vitamin D assays.

ICD-10 Description for Vitamin D Assays (CPT 82306):

  • M81.0: Age-Related Osteoporosis without Current Pathological Fracture
  • E83.52: Hypercalcemia
  • E83.51: Hypocalcemia
  • M81.8: Other Osteoporosis without Current Pathological Fracture
  • E55.9: Vitamin D Deficiency Unspecified

ICD-10 Description for Assay of Ascorbic Acid (CPT 82180):

  • V12.1: Personal history of nutrition deficiency
  • V45.11: Renal dialysis status
  • V45.3: Intestinal bypass or anastomosis status
  • V58.11: Encounter for antineoplastic chemotherapy
  • V58.69: Long-term current use of other medications

Payment Basics:

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Conclusion:

In the ever-evolving landscape of Medicare guidelines, providers must stay vigilant and informed, utilizing available resources for accurate billing and optimal reimbursement.

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