CommercialCoverageHigh impact
Vitamin D Assay (CPB 0945, reviewed 2025-12-23)
Aetna·Endocrinology, Nephrology, Internal Medicine +5 more·Medical Policy
We identified it
Aug 12, 2026
Summary
Aetna's Vitamin D Assay policy (CPB 0945) designates routine preventive vitamin D screening as experimental and investigational, limiting coverage to specific clinical conditions listed in the policy. Billing teams must verify ICD-10 diagnosis codes match approved indications before submitting claims for CPT codes 0038U, 82306, or 82652, as claims lacking qualifying diagnoses will be denied.
Action Required
IMMEDIATE ACTION REQUIRED: Billing team must implement diagnosis code validation in billing system for all vitamin D assay claims (CPT 0038U, 82306, 82652). Before submitting ANY vitamin D testing claims: (1) Verify patient's primary ICD-10 diagnosis matches ONLY the covered indications listed in policy (tuberculosis, HIV/AIDS, sarcoidosis, cystic fibrosis, CKD, vitamin D deficiency, rickets, hyperparathyroidism, celiac disease, bariatric surgery status, long-term steroid use, transplant status, and related conditions); (2) Reject or hold claims with non-covered diagnoses including diabetes, COPD, cancer screening, pregnancy, psoriasis, fibromyalgia, dementia, or Parkinson's disease; (3) Update EMR/billing software with hard-stop edits to flag claims lacking qualifying diagnoses; (4) Notify providers that routine vitamin D screening cannot be billed to Aetna—only disease-specific vitamin D testing is reimbursable. Claims submitted without qualifying diagnosis codes will be denied. No effective date is specified; this policy review date is 2025-12-23, indicating current enforcement.