The Special Investigations Unit (SIU) is tasked to conduct investigations involving allegations of fraud, waste and abuse, to work with our providers to resolve billing practice issues in order to reduce or eliminate future payment issues, and, where appropriate, to recover overpayments.  

As part of Anthem Blue Cross’ (Anthem) role to safeguard our members and provide relevant information to providers we are relaying the following information regarding clinical guideline CG-LAB-11.

This document addresses routine testing of serum vitamin D levels in adults and children where there is an absence of clinical signs and symptoms of vitamin D deficiency or intoxication or conditions for which vitamin D supplementation may be recommended. Vitamin D testing is a non-invasive blood test which can aid in the identification and clinical management of individuals at-risk for vitamin D deficiency. Testing vitamin D levels in individuals with no known signs or symptoms of vitamin D deficiency or intoxication nor conditions for which vitamin D treatment is recommended is considered not medically necessary.


When services are Not Medically Necessary:

When the code describes a procedure specified in the Clinical Indications section as not medically necessary.

CPT Code

Description

82306

Vitamin D; 25 hydroxy, includes fraction(s), if performed [when specified as screening]

82652

Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed [when specified as screening]

0038U

Vitamin D, 25 hydroxy D2 and D3, by LCMS/MS, serum microsample, quantitative Sensieva Droplet 250H Vitamin D2/D3 Microvolume LC/MS Assay; InSource Diagnostics


ICD-10

Diagnosis including but not limited to the following:

Z00.00

Encounter for general adult medical examination without abnormal findings

Z00.129

Encounter for routine child health examination without abnormal findings

Z01.419

Encounter for gynecological examination (general) (routine) without abnormal findings


Further details regarding this policy can be found at https://www.anthem.com/ca/provider/policies/clinical-guidelines/


Laboratory Panel Testing


As a reminder, the use of a pre-determined panel of testing which includes tests for which there is no medical necessity for the individual patient should be avoided.  Pre-determined laboratory panel testing for all patients regardless of individual patient presentation, does not address the individual needs of the patient and may be considered unsupported for purposes of payment.  Please review any such panel testing that may include testing for Vitamin D to ensure that it is in fact appropriate for the patient in compliance with CG-LAB-11.

1063-0421-PN-CA



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April 2021 Anthem Blue Cross Provider News - California