CPT code 82306 refers to the lab test for 25-hydroxyvitamin D, commonly known as the vitamin D blood test. In 2025, proper billing of this code is essential due to stricter payer guidelines and limited coverage for routine screening. This guide explores what CPT 82306 entails, which diagnoses support it, and how the latest policies impact reimbursement.
What Is CPT Code 82306?
CPT code 82306 represents the serum test for 25-hydroxyvitamin D (25[OH]D), the primary circulating form of vitamin D. This test evaluates a patient’s vitamin D status, which is crucial for bone health, calcium absorption, and overall endocrine function. Clinicians often order 82306 for patients with suspected deficiencies, metabolic disorders, or bone-related conditions like osteoporosis.
Medical Necessity in 2025: When Is 82306 Covered?
As of 2025, most payers—including Medicare—do not cover CPT 82306 for general population screening. Instead, the test must be linked to a medically necessary reason. Acceptable indications include:
- Chronic kidney disease (Stage III or higher)
- Hypocalcemia or hypercalcemia
- Parathyroid disorders (e.g., hypoparathyroidism)
- Osteoporosis, osteomalacia, or osteopenia
- Malabsorption syndromes (e.g., celiac disease, Crohn’s)
- Vitamin D toxicity or deficiency (must be specific)
Make sure to use an approved ICD-10 code that clearly supports medical necessity. Avoid relying solely on unspecified codes like E55.9; many payers reject claims using this code without additional detail.
2025 Payer Updates: Frequency Limits & Bundling Rules
Most insurers have clarified coverage frequency for vitamin D testing:
- Medicare: No national coverage; refer to LCDs for conditions and frequency (typically annual testing).
- Cigna (2025): Allows up to 2 tests per 12-month period. Exceeding this limit requires conditions like CKD, malabsorption, or hypoparathyroidism.
- Medicaid (varies by state): Often allows 3–4 tests/year with proper diagnosis linkage.
Additionally, some insurers prohibit billing both 82306 and 82652 (vitamin D2 and D3 separately) on the same day unless medically necessary. Always check payer-specific bundling rules.
Billing Guidelines: How to Submit CPT 82306 Correctly
For accurate billing and reduced denials, follow these steps:
- Enter 82306 in Box 24D of the CMS-1500 claim form.
- Include an approved ICD-10 code in Box 21 to justify medical necessity.
- Use correct ICD pointers (A–L) to link diagnosis and CPT.
- List the referring/ordering provider’s NPI in Box 17.
- Include the CLIA number in Box 23 if billing for an external lab.
If billing Medicare and the test isn’t covered under current LCDs, issue an ABN (Advance Beneficiary Notice) to shift financial liability to the patient.
Documentation Tips for Coders & Billers
Effective documentation is key to getting paid. Here are some practical tips:
- Clearly state the reason for testing in the clinical note (e.g., “Patient has history of osteomalacia and vitamin D deficiency”).
- Match diagnosis codes to the clinical rationale and ensure specificity.
- Avoid vague or non-specific diagnoses for justification.
- Ensure ordering providers document necessity—especially for repeat tests.
Frequently Asked Questions
What ICD-10 codes support CPT 82306?
Examples include N18.3+ (CKD), E20.x (hypoparathyroidism), K90.x (malabsorption), M83.x (osteomalacia), and more. Avoid using E55.9 alone unless accompanied by a more detailed diagnosis.
How often can 82306 be billed in 2025?
Frequency varies by payer. Cigna allows twice annually, Medicare typically once per year, and Medicaid varies by state. Clinical justification is required for additional tests.
What if my 82306 claim is denied?
Review the ICD-10 code used and compare it with the payer’s policy. Submit documentation with your appeal showing medical necessity. If appropriate, consider issuing an ABN for future services.
Conclusion
The 82306 CPT code plays a vital role in managing bone health and vitamin D deficiency. However, billing this code in 2025 requires adherence to specific payer guidelines, supported diagnoses, and frequency limits. By ensuring proper documentation, using correct ICD-10 codes, and staying current on payer rules, billers and coders can minimize denials and maintain revenue cycle compliance.
Need help with claim accuracy? Check out our resources on completing the CMS-1500 form and referring vs. ordering physician documentation for lab services.