Vitamin B-12 Therapy (CPB 0536, reviewed 2025-08-21)
Aetna covers intramuscular or subcutaneous vitamin B-12 injections as medically necessary only for members with current or previously documented B-12 deficiency and one of the listed diagnoses, including pernicious anemia, malabsorption syndromes, gastrectomy or small intestine surgery, certain neuropathies, dementia secondary to B-12 deficiency, metformin-related deficiency, methotrexate or pralatrexate use, and pemetrexed (Alimta) use. Aetna considers vitamin B-12 injections for all other indications experimental, investigational or unproven, including autism, depression, fibromyalgia, migraine prophylaxis, and weight loss. Homocysteine measurement is medically necessary in persons with borderline vitamin B-12 deficiency when the results will impact the member's management, while holotranscobalamin measurement for diagnosing B-12 deficiency is listed as unproven.