Will Medicare cover checking vitamin D and B12 levels at the same time?

Medicare Coverage for Simultaneous Vitamin D and B12 Testing

Medicare does not restrict checking vitamin D and B12 levels at the same time, but coverage depends on meeting specific medical necessity criteria for each test individually. Medicare requires documented clinical indications for both tests to provide reimbursement, rather than routine screening 1.

Medicare Coverage Requirements

For Vitamin B12 Testing

Medicare will cover B12 testing when you document specific risk factors or clinical indications, including 1, 2:

• Metformin use for more than 4 months - particularly important as long-term metformin is associated with biochemical B12 deficiency 1
• Proton pump inhibitor or H2 blocker use for more than 12 months 2
• History of gastric or small intestine resection 2
• Inflammatory bowel disease 2
• Age over 75 years 2
• Vegan or strict vegetarian diet 2
• Symptoms suggesting deficiency: anemia, peripheral neuropathy, cognitive difficulties, memory problems, or fatigue 3

For Vitamin D Testing

Medicare coverage for vitamin D testing is more restrictive 4, 5:

• Routine screening is NOT covered - the USPSTF concludes evidence for screening asymptomatic adults is insufficient 4
• Coverage requires documented conditions such as:
  • Chronic kidney disease 1
  • Malabsorption disorders 1
  • Hyperparathyroidism 5
  • Osteoporosis or high fracture risk 1
  • Specific medications affecting vitamin D metabolism 1

Practical Approach for Ordering

To ensure Medicare coverage when ordering both tests simultaneously:

1. Document specific medical necessity for each test separately in the medical record 1, 2
2. Use appropriate ICD-10 codes that justify each test individually (not "screening" codes) 5
3. Note relevant risk factors - for example, if the patient takes metformin, document duration of use and consider B12 monitoring 1
4. Avoid ordering as routine screening - Medicare specifically does not cover vitamin D screening in asymptomatic adults 4

Common Pitfalls to Avoid

• Don't order vitamin D "just to check" without documented clinical indication - this resulted in 76.5% of tests having no valid indication after Medicare criteria tightened in Australia, suggesting similar issues in the US 5
• Don't assume age alone justifies vitamin D testing - you need specific conditions beyond age 4
• For B12, metformin use is one of the strongest justifications - but document the duration (>4 months) explicitly 1, 2
• Consider checking methylmalonic acid (MMA) if B12 results are indeterminate rather than repeat B12 testing, though this is more expensive 1, 3

The key point: Medicare allows simultaneous testing, but each test must independently meet medical necessity criteria with proper documentation. Simply wanting to check both levels without clinical justification will likely result in denied claims 4, 5.