Posted in Insurance, Training, Updates

1199 SEIU Benefits Fund-Vitamin D testing – 09/01/2020

In order to ensure that 1199 SEIU Benefits Fund members get the proper medically necessary care, 1199 SEIU has implemented a new Vitamin D testing policy.

This policy will become effective 09/01/2020- 1199 SEIU Benefits Fund will pay for VITAMIN D testing for the following indications:

  • Medical Diagnosis associated with Vitamin D deficiency
  • Documented Vitamin D deficiency
  • Known or suspected excessive Vitamin D blood levels

Vitamin D testing is NOT considered medically necessary for the following:

  • Routine Preventative Screening test
  • All other indications

Coding and Billing:

The following Codes will be accepted:

82306- vitamin D; 25 hydroxy, includes fractions, if performed

82652- Vitamin D; 1,25 dihydroxy, includes fraction (s), if performed

Claims that are submitted with BOTH codes in combination, on the same day, are considered not medically necessary and will be denied.

In addition, code 0038U is currently not covered.

If providers have any questions regarding this policy, they can contact the 1199 SEIU Benefits Fund Provider Relations Department at 646-473-7160, Monday through Friday, from 9:00 AM to 5:00 PM.

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Posted in In The Know Series, Insurance, My services

Anthem BCBS members: Screening for Vitamin D Deficiency in Average Risk Individuals

Previously, I published an article regarding Aetna Vitamin D Testing (click here to view it)

The following is the policy for Anthem BCBS:

Things to consider:

  1. Original date for this policy is 09/13/2017
  2. Policy was updated and reviewed on 08/22/2019
  3. Publish date: 09/25/2019
  4. The updated sections: discussion and general information
  5. Note the coding section provided
  6. Note the recommendation section in the policy

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Posted in In The Know Series, Insurance, My services, Payers and CPT reinbursement, Training

Aetna and Vitamin D assay testing- 2019

Last week I had a conversation with one of employees that works in the OBGYN office.

She said: ” Kate, I have a very large pile of denials on my desk. They all have to do with Vitamin D testing/screening for my Aetna patients. In the previous years, our office had no problem with testing women for Vitamin D. Now I have no idea what is going on? Is there anyway you can help me out?”

I said: “Sure, let me look in to it and I will let you know by tomorrow.”

Later that day I find out the following:

According to Aetna the Vitamin D assay testing is considered to be experimental and investigational for routine preventative screenings. 

The next day I tell that employee what I found out.

She says: ” Wow. None of the people in my billing department had any answer for me! Thank you very much. I will pass this information on to both my clinical staff and my billing department. You are a big help!”