PROCEDURE CODES: 82306, 82652 Vitamin D Assay Testing

1 2020. MEDICARE LOCAL COVERAGE ARTICLE (LCA) - A57718. PROCEDURE CODES: 82306, 82652 . Vitamin D Assay Testing For services performed on or after 2-3-2017. DLS TEST CODE AND NAME. 49907 Vitamin D (1,25 DIHYDROXY) (Proc Code: 82652 ). 56799 Vitamin D, 25-HYDROXY (D2 & D3) (Proc Code: 82306). 65560 Vitamin D, 25-HYDROXY, TOTAL (Proc Code: 82306). The following ICD-10-CM codes support the medical necessity of PROCEDURE code 82652 . ICD-10 CODE DESCRIPTION. Rickets, active Vitamin D deficiency, unspecified Unspecified disorder of calcium metabolism *. *Use only for unexplained hypercalciuria * Hypercalcemia *Use only for unexplained hypercalcemia Puerperal osteomalacia Senile osteomalacia Adult osteomalacia due to malabsorption Adult osteomalacia due to malnutrition Aluminum bone disease Other drug-induced osteomalacia in adults Other adult osteomalacia * Adult osteomalacia, unspecified *Use only for tumor-induced osteomalacia Calculus of kidney Calculus of ureter Calculus of kidney with calculus of ureter Urinary calculus, unspecified N22 Calculus of urinary tract in diseases classified elsewhere The following ICD-10-CM codes support the medical necessity of PROCEDURE code 82306.

2 ICD-10 CODE DESCRIPTION. Tuberculosis of lung Tuberculosis of intrathoracic lymph nodes Tuberculosis of larynx, trachea and bronchus Tuberculous pleurisy Primary respiratory tuberculosis Other respiratory tuberculosis Tuberculous meningitis Meningeal tuberculoma Tuberculoma of brain and spinal cord Tuberculous meningoencephalitis Source: Vitamin D. Effective Date: 02 03 2017, last updated 10 1 2020 1 of 9. The following ICD-10-CM codes support the medical necessity of PROCEDURE code 82306. ICD-10 CODE DESCRIPTION. Tuberculous neuritis Other tuberculosis of nervous system Tuberculosis of spine Tuberculous arthritis of other joints Tuberculosis of other bones Other musculoskeletal tuberculosis Tuberculosis of kidney and ureter Tuberculosis of bladder Tuberculosis of other urinary organs Tuberculosis of prostate Tuberculosis of other male genital organs Tuberculosis of cervix Tuberculous female pelvic inflammatory disease Tuberculosis of other female genital organs Tuberculous peripheral lymphadenopathy Tuberculous peritonitis Tuberculous enteritis Retroperitoneal tuberculosis Tuberculosis of skin and subcutaneous tissue Tuberculous episcleritis Tuberculous keratitis Tuberculous chorioretinitis Tuberculous iridocyclitis Other tuberculosis of eye Tuberculosis of (inner) (middle)

3 Ear Tuberculosis of adrenal glands Tuberculosis of thyroid gland Tuberculosis of other endocrine glands Tuberculosis of digestive tract organs, not elsewhere classified Tuberculosis of heart Tuberculosis of spleen Tuberculosis of other sites Acute miliary tuberculosis of a single specified site Acute miliary tuberculosis of multiple sites Acute miliary tuberculosis, unspecified Other miliary tuberculosis Acute pulmonary coccidioidomycosis Chronic pulmonary coccidioidomycosis Cutaneous coccidioidomycosis Coccidioidomycosis meningitis Disseminated coccidioidomycosis Prostatic coccidioidomycosis Other forms of coccidioidomycosis Acute pulmonary histoplasmosis capsulati Chronic pulmonary histoplasmosis capsulati Source: Vitamin D. Effective Date: 02 03 2017, last updated 10 1 2020 2 of 9. The following ICD-10-CM codes support the medical necessity of PROCEDURE code 82306. ICD-10 CODE DESCRIPTION. Disseminated histoplasmosis capsulati Histoplasmosis duboisii Follicular lymphoma grade I, lymph nodes of head, face, and neck Follicular lymphoma grade I, intrathoracic lymph nodes Follicular lymphoma grade I, intra-abdominal lymph nodes Follicular lymphoma grade I, lymph nodes of axilla and upper limb Follicular lymphoma grade I, lymph nodes of inguinal region and lower limb Follicular lymphoma grade I, intrapelvic lymph nodes Follicular lymphoma grade I, spleen Follicular lymphoma grade I, lymph nodes of multiple sites Follicular lymphoma grade I, extranodal and solid organ sites Follicular lymphoma grade II, lymph nodes of head, face, and neck Follicular lymphoma grade II, intrathoracic lymph nodes Follicular lymphoma grade II, intra-abdominal lymph nodes Follicular lymphoma grade II, lymph nodes of axilla and upper limb Follicular lymphoma grade II, lymph nodes of inguinal region and lower limb Follicular lymphoma grade II.

4 Intrapelvic lymph nodes Follicular lymphoma grade II, spleen Follicular lymphoma grade II, lymph nodes of multiple sites Follicular lymphoma grade II, extranodal and solid organ sites Follicular lymphoma grade III, unspecified, lymph nodes of head, face, and neck Follicular lymphoma grade III, unspecified, intrathoracic lymph nodes Follicular lymphoma grade III, unspecified, intra-abdominal lymph nodes Follicular lymphoma grade III, unspecified, lymph nodes of axilla and upper limb Follicular lymphoma grade III, unspecified, lymph nodes of inguinal region and lower limb Follicular lymphoma grade III, unspecified, intrapelvic lymph nodes Follicular lymphoma grade III, unspecified, spleen Follicular lymphoma grade III, unspecified, lymph nodes of multiple sites Follicular lymphoma grade III, unspecified, extranodal and solid organ sites Follicular lymphoma grade IIIa, lymph nodes of head, face, and neck Follicular lymphoma grade IIIa, intrathoracic lymph nodes Follicular lymphoma grade IIIa, intra-abdominal lymph nodes Follicular lymphoma grade IIIa, lymph nodes of axilla and upper limb Follicular lymphoma grade IIIa, lymph nodes of inguinal region and lower limb Follicular lymphoma grade IIIa, intrapelvic lymph nodes Follicular lymphoma grade IIIa, spleen Follicular lymphoma grade IIIa, lymph nodes of multiple sites Follicular lymphoma grade IIIa, extranodal and solid organ sites Follicular lymphoma grade IIIb, lymph nodes of head, face, and neck Follicular lymphoma grade IIIb, intrathoracic lymph nodes Follicular lymphoma grade IIIb, intra-abdominal lymph nodes Follicular lymphoma grade IIIb, lymph nodes of axilla and upper limb Follicular lymphoma grade IIIb, lymph nodes of inguinal region and lower limb Follicular lymphoma grade IIIb, intrapelvic lymph nodes Source: Vitamin D.

5 Effective Date: 02 03 2017, last updated 10 1 2020 3 of 9. The following ICD-10-CM codes support the medical necessity of PROCEDURE code 82306. ICD-10 CODE DESCRIPTION. Follicular lymphoma grade IIIb, spleen Follicular lymphoma grade IIIb, lymph nodes of multiple sites Follicular lymphoma grade IIIb, extranodal and solid organ sites Diffuse follicle center lymphoma, lymph nodes of head, face, and neck Diffuse follicle center lymphoma, intrathoracic lymph nodes Diffuse follicle center lymphoma, intra-abdominal lymph nodes Diffuse follicle center lymphoma, lymph nodes of axilla and upper limb Diffuse follicle center lymphoma, lymph nodes of inguinal region and lower limb Diffuse follicle center lymphoma, intrapelvic lymph nodes Diffuse follicle center lymphoma, spleen Diffuse follicle center lymphoma, lymph nodes of multiple sites Diffuse follicle center lymphoma, extranodal and solid organ sites Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck Cutaneous follicle center lymphoma, intrathoracic lymph nodes Cutaneous follicle center lymphoma.

6 Intra-abdominal lymph nodes Cutaneous follicle center lymphoma, lymph nodes of axilla and upper limb Cutaneous follicle center lymphoma, lymph nodes of inguinal region and lower limb Cutaneous follicle center lymphoma, intrapelvic lymph nodes Cutaneous follicle center lymphoma, spleen Cutaneous follicle center lymphoma, lymph nodes of multiple sites Cutaneous follicle center lymphoma, extranodal and solid organ sites Other types of follicular lymphoma, lymph nodes of head, face, and neck Other types of follicular lymphoma, intrathoracic lymph nodes Other types of follicular lymphoma, intra-abdominal lymph nodes Other types of follicular lymphoma, lymph nodes of axilla and upper limb Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb Other types of follicular lymphoma, intrapelvic lymph nodes Other types of follicular lymphoma, spleen Other types of follicular lymphoma, lymph nodes of multiple sites Other types of follicular lymphoma, extranodal and solid organ sites Follicular lymphoma, unspecified, lymph nodes of head, face, and neck Follicular lymphoma, unspecified, intrathoracic lymph nodes Follicular lymphoma, unspecified, intra-abdominal lymph nodes Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb Follicular lymphoma, unspecified, lymph nodes of inguinal region and lower limb Follicular lymphoma, unspecified, intrapelvic lymph nodes Follicular lymphoma, unspecified, spleen Follicular lymphoma, unspecified, lymph nodes of multiple sites Follicular lymphoma, unspecified, extranodal and solid organ sites Hereditary hypogammaglobulinemia Nonfamilial hypogammaglobulinemia Selective deficiency of immunoglobulin A [IgA].

7 Selective deficiency of immunoglobulin G [IgG] subclasses Selective deficiency of immunoglobulin M [IgM]. Source: Vitamin D. Effective Date: 02 03 2017, last updated 10 1 2020 4 of 9. The following ICD-10-CM codes support the medical necessity of PROCEDURE code 82306. ICD-10 CODE DESCRIPTION. Immunodeficiency with increased immunoglobulin M [IgM]. Antibody deficiency with near-normal immunoglobulins or with hyperimmunoglobulinemia Transient hypogammaglobulinemia of infancy Other immunodeficiencies with predominantly antibody defects Immunodeficiency with predominantly antibody defects, unspecified Acute graft-versus-host disease Chronic graft-versus-host disease Acute on chronic graft-versus-host disease Graft-versus-host disease, unspecified Cytokine release syndrome, grade 1. Cytokine release syndrome, grade 2. Cytokine release syndrome, grade 3. Cytokine release syndrome, grade 4. Cytokine release syndrome, grade 5. Cytokine release syndrome, grade unspecified Idiopathic hypoparathyroidism Other hypoparathyroidism Hypoparathyroidism, unspecified Primary hyperparathyroidism Secondary hyperparathyroidism, not elsewhere classified Other hyperparathyroidism Hyperparathyroidism, unspecified E41 Nutritional marasmus E43 Unspecified severe protein-calorie malnutrition Rickets, active * Vitamin D deficiency, unspecified Hypervitaminosis D.

8 Other specified hyperalimentation E68 Sequelae of hyperalimentation Disorder of phosphorus metabolism, unspecified Familial hypophosphatemia Hereditary Vitamin D-dependent rickets (type 1) (type 2). Other disorders of phosphorus metabolism * Unspecified disorder of calcium metabolism Hypocalcemia Hypercalcemia Cystic fibrosis with pulmonary manifestations Meconium ileus in cystic fibrosis Cystic fibrosis with other intestinal manifestations Cystic fibrosis with other manifestations Cystic fibrosis, unspecified Postprocedural hypoparathyroidism Postprocedural hematoma of an endocrine system organ or structure following an endocrine system PROCEDURE Source: Vitamin D. Effective Date: 02 03 2017, last updated 10 1 2020 5 of 9. The following ICD-10-CM codes support the medical necessity of PROCEDURE code 82306. ICD-10 CODE DESCRIPTION. Postprocedural hematoma of an endocrine system organ or structure following other PROCEDURE Postprocedural seroma of an endocrine system organ or structure following an endocrine system PROCEDURE Postprocedural seroma of an endocrine system organ or structure following other PROCEDURE Berylliosis Crohn's disease of small intestine without complications Crohn's disease of small intestine with rectal bleeding Crohn's disease of small intestine with intestinal obstruction Crohn's disease of small intestine with fistula Crohn's disease of small intestine with abscess Crohn's disease of small intestine with other complication Crohn's disease of small intestine with unspecified complications Crohn's disease of large intestine without complications Crohn's disease of large intestine with rectal bleeding Crohn's disease of large intestine with intestinal obstruction Crohn's disease of large intestine with fistula Crohn's disease of large

9 Intestine with abscess Crohn's disease of large intestine with other complication Crohn's disease of large intestine with unspecified complications Crohn's disease of both small and large intestine without complications Crohn's disease of both small and large intestine with rectal bleeding Crohn's disease of both small and large intestine with intestinal obstruction Crohn's disease of both small and large intestine with fistula Crohn's disease of both small and large intestine with abscess Crohn's disease of both small and large intestine with other complication Crohn's disease of both small and large intestine with unspecified complications Crohn's disease, unspecified, without complications Crohn's disease, unspecified, with rectal bleeding Crohn's disease, unspecified, with intestinal obstruction Crohn's disease, unspecified, with fistula Crohn's disease, unspecified, with abscess Crohn's disease, unspecified, with other complication Gastroenteritis and colitis due to radiation Alcoholic fibrosis and sclerosis of liver Alcoholic cirrhosis of liver without ascites Alcoholic cirrhosis of liver with ascites Hepatic fibrosis, unspecified Hepatic fibrosis, early fibrosis Hepatic fibrosis, advanced fibrosis Hepatic sclerosis Hepatic fibrosis with hepatic sclerosis Primary biliary cirrhosis Secondary biliary cirrhosis Source: Vitamin D.

10 Effective Date: 02 03 2017, last updated 10 1 2020 6 of 9. The following ICD-10-CM codes support the medical necessity of PROCEDURE code 82306. ICD-10 CODE DESCRIPTION. Biliary cirrhosis, unspecified Unspecified cirrhosis of liver Other cirrhosis of liver Liver disease, unspecified Biliary cyst Other specified diseases of biliary tract Idiopathic acute pancreatitis without necrosis or infection Idiopathic acute pancreatitis with uninfected necrosis Idiopathic acute pancreatitis with infected necrosis Biliary acute pancreatitis without necrosis or infection Biliary acute pancreatitis with uninfected necrosis Biliary acute pancreatitis with infected necrosis Alcohol induced acute pancreatitis without necrosis or infection Alcohol induced acute pancreatitis