Medicare and Vitamin D Tests

cinnamonsmiles · February 2015

I had a Vitamin D test and Medicare refused to pay for it. I was told by the billing and coding department that Medicare never pays for it. I called Medicare and was told, yes, Medicare can pay for it. I asked about how the clinic should bill it and code and Medicare would not tell me.

Because of the bad service I received and being lied to, the clinic footed the over $200 bill for the Vitamin D level test.

I am due for another test and can't afford to pay that out of pocket.

Does anyone know how to bill and code Vitamin D level tests so Medicare pays for it?

Thanks!

Jelson · February 2015

Your question interested me because I am scheduled for my last annual physical after which I will be covered by Medicare. Having had vitamin D testing perhaps 3 times at my request due to the potential link to breast cancer, I will be sure to talk with my primary care physician about it and any other Medicare coverage surprises awaiting me. I googled Medicare reimbursement for vitamin d testing and from my skimming a few entries, found that many decisions are made at a local level. I found a Michigan advisory statement for Jan 2014 that listed the diagnoses that would be considered acceptable for Vitamin D testing - http://www.questdiagnostics.com/dms/Documents/mlcp/Tool7.pdf and another, more recent advisory which included some other states - but for Vitamin D assay. I don't know the significance of the difference in terms. Apparently vitamin d testing is expensive and it has become very popular ie routine screening and Medicare doesn't seem to have the wherewithal to negotiate lower payments so they are cutting costs by limiting access by stating it is not a screening test and must be medically necessary and then strictly defining those diagnoses. they keep mentioning rickets, like what someone in CMS audit remembered from their 8th grade biology...

sorry

AaronCook · March 2015

I came across on this page because it is also the problem of my wife. But unfortunately, we were told that Vitamin D testing is not covered by Medicare. Now we are looking for other options for preventive care that is guaranteed by other health care providers.

crabbiepattie · March 2015

Sorry I can't help with the Medicare issue, but I just want to point out that you can order a Vitamin D blood test as a self-pay patient without a doctor's order for $50-$70 on the Vitamin D Council website, Life Extension's website, Direct Access Labs' website or many others. The Vitamin D Council test is a blood spot test you do at home and mail in. Most other websites require you to go to a local lab for the blood draw (usually no extra cost) and they will run the test and send you the results. I'm familiar with this approach because some thyroid patients order thyroid tests their doctors won't order.

bride · March 2015

The best information I could find dates to 2013 and can be found here: www.paml.com/files/billinghandbook/billing_guide_paml.pdf

It seems that Medicare no longer wants to support routine Vit. D screenings. Now Medicare demands a medical necessity and has defined what it deems to be a medical necessity in its codes. Although the link above is to a huge PDF file, the info on Vit. D can be found within the first 20 pages. This PDF also lists all the minutiae that has to be submitted to them.

In addition to the federal Medicare system, many states will pay when the Feds won't but only if you follow the state's codes and other detailed junk. The link above has a link to several states' policies of Vit. D testing. It also has an interactive link where you can submit trial codings and see if they'll work.

I asked a friend about it (she does non-Medicare coding) and shesuggested that if your DEXA score is -2 or worse, you'd be Medicare eligible. In the link there around 30 various coding possibilities.

I hope this helps,

bride

Medicare and Vitamin D Tests

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