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.

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

Not for screening of vitamin D deficiency in asymptomatic adults - Prevention TaskForce Search (uspreventiveservicestaskforce.org)

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.