CPT Coding for Vitamin D Level Testing
The CPT code for vitamin D level testing is 82306, which covers measurement of 25-hydroxyvitamin D (25-OHD), the standard biomarker for assessing vitamin D status.
Understanding the Test
The 25-hydroxyvitamin D test is the accepted laboratory measure for determining vitamin D status, though significant variability exists between testing methods and laboratories 1. Multiple testing methodologies are available including:
- Competitive protein binding assays
- Immunoassays
- High-performance liquid chromatography (HPLC)
- Liquid chromatography-tandem mass spectrometry (LC-MS/MS) 1, 2, 3
LC-MS/MS has become the gold standard methodology with reference method procedures accepted by the Joint Committee for Traceability in Laboratory Medicine 1.
Coverage Considerations
When Testing May Be Appropriate
While the U.S. Preventive Services Task Force concludes that evidence is insufficient to recommend routine screening in asymptomatic adults 1, testing may be considered for patients with specific risk factors:
- Low vitamin D intake or decreased absorption 1
- Minimal sun exposure (winter season, high latitude, physical sun avoidance) 1
- Obesity (though clinical significance of low levels in this population remains unclear) 1
- Darker skin pigmentation 1
- Bone, endocrine, or autoimmune diseases (considered disease management rather than screening) 1
When Testing Is Not Recommended
Routine screening of asymptomatic, community-dwelling adults without risk factors is not supported by current evidence 1. The USPSTF gives this an "I" statement (insufficient evidence) 1.
Important Caveats
Test Variability Issues
Classification of samples as "deficient" or "nondeficient" can vary by 4% to 32% depending on which assay is used 1. Testing variability between methods and between laboratories using the same method ranges from 10% to 20% 1, 2.
The Centers for Disease Control and Prevention offers the Vitamin D Standardization Certification Program to help laboratories maintain quality and comparability of results 1.
Clinical Context Matters
Testing in patients with bone, endocrine, or autoimmune diseases should be billed as disease management rather than screening 1. Vitamin D testing during pregnancy is considered outside the scope of general screening due to unique nutritional demands 1.
Increasing Utilization Trends
Despite insufficient evidence for routine screening, testing rates have increased dramatically. The annual rate of outpatient visits associated with vitamin D deficiency diagnosis more than tripled between 2008 and 2010 (reaching 1,177 visits per 100,000 population) 1. Total serum 25-OHD testing increased by at least 50% year-over-year in more than half of clinical laboratories surveyed in 2009 1.