Sign in →

Test Code 25HDN 25-Hydroxyvitamin D2 and D3, Serum

Important Note

Vitamin D Medical Necessity - This communication is intended to provide education regarding medical necessity requirements for Vitamin D Assay testing.  There are Local Coverage Determinations (LCDs) and Local Coverage Article (LCAs) for guidance when ordering the Vitamin D Assay Test.   We are seeing many commercial payers adhering to these same medical necessity requirements.   When medical necessity is not met patients are financially responsible or if no waiver or Advanced Beneficiary notice (ABN) is obtained, SCHS must absorb the cost. 

Providers are responsible to provide ICD-10 codes to the highest level of specificity. SCHS is requesting providers to review the guidance provided from CMS for proper coding, documentation, and medical necessity requirements.

CMS guidance LCD/LCA ID: L34051 (A57719), found on website: csm.gov

Article - Billing and Coding: Vitamin D Assay Testing (A57719) (cms.gov)

Regency.com (commercial coverage) will not cover Vitamin D testing for E55.9 Vit D deficiency, unspecified.  Please review link for medical necessity informaiton. Vitamin D Testing (regence.com) starts on page 37.

When ordering the Vitamin D testing on an outpatient, and the medical necessity criteria is not met, it is the responsibility of the facility or provider obtaining the specimen to share with their patient and obtain a signed waiver, or Advanced Beneficiary notice (ABN), prior to the patient being drawn. This allows the beneficiary to make an informed decision to be financially responsible. 

St. Charles Health System does have a Patient Financial Assistance Policy to offer options for financial assistance for those who are unable to pay for the cost of their laboratory services.  Your patients can access our website at http://www.stcharleshealthcare.org/For-Patients/Billing-and-Insurance for additional information or call 541-706-7750 and press 2.     

On behalf of St. Charles Laboratories, we appreciate the opportunity to serve you and your patients.

Please contact St. Charles Laboratory Support Services Supervisor at 541-706-6387, with any questions.

Additional Codes

Internal: 11537

External: VITD2D3

Beaker: LAB4077

Reporting Name

25-Hydroxyvitamin D2 and D3, S

Useful For

Diagnosis of vitamin D deficiency

 

Differential diagnosis of causes of rickets and osteomalacia

 

Monitoring vitamin D replacement therapy

 

Diagnosis of hypervitaminosis D

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Serum


Specimen Required


Collection Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Submission Container/Tube: Plastic vial

Specimen Volume: 0.5 mL

Collection Instructions: Centrifuge and aliquot serum into a plastic vial within 2 hours of specimen collection.


Specimen Minimum Volume

0.25 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 28 days
  Frozen  30 days
  Ambient  7 days

Reference Values

TOTAL 25-HYDROXYVITAMIN D2 AND D3 (25-OH-VitD)

<10 ng/mL (severe deficiency)*

10-19 ng/mL (mild to moderate deficiency)**

20-50 ng/mL (optimum levels)***

51-80 ng/mL (increased risk of hypercalciuria)****

>80 ng/mL (toxicity possible)*****

 

*Could be associated with osteomalacia or rickets

**Might be associated with increased risk of osteoporosis or secondary hyperparathyroidism

***Optimum levels in the healthy population

****Sustained levels >50 ng/mL 25OH-VitD along with prolonged calcium supplementation may lead to hypercalciuria and decreased kidney function

*****80 ng/mL is the lowest reported level associated with toxicity in patients without primary hyperparathyroidism who have normal kidney function. Most patients with toxicity have levels >150 ng/mL. Patients with kidney failure can have very high 25-OH-VitD levels without any signs of toxicity, as renal conversion to the active hormone 1,25-OH-VitD is impaired or absent.

 

These reference ranges represent clinical decision values, based on the 2011 Institute of Medicine report, that apply to males and females of all ages, rather than population-based reference values. Population reference ranges for 25-OH-VitD vary widely depending on ethnic background, age, geographic location of the studied populations, and the sampling season. Population-based ranges correlate poorly with serum 25-OH-VitD concentrations that are associated with biologically and clinically relevant vitamin D effects and are therefore of limited clinical value.

 

For International System of Units (SI) conversion for Reference Values, see www.mayocliniclabs.com/order-tests/si-unit-conversion.html.

Day(s) Performed

Monday through Friday

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

82306

LOINC Code Information

Test ID Test Order Name Order LOINC Value
25HDN 25-Hydroxyvitamin D2 and D3, S 49590-3

 

Result ID Test Result Name Result LOINC Value
2897 25-Hydroxy D2 49054-0
2898 25-Hydroxy D3 1989-3
83670 25-Hydroxy D Total 62292-8

Report Available

2 to 5 days

Reject Due To

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK

Method Name

Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)

 

Portions of this test are covered by patents held by Quest Diagnostics

Forms

If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-General Request (T239)

-Renal Diagnostics Test Request (T830)

Secondary ID

83670