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April 26, 2021

Vitamin D Deficiency Screening in Adults

Vitamin D (also referred to as "calciferol") is a fat-soluble vitamin that is naturally present in a few foods, added to others, and available as a dietary supplement. It is also produced endogenously when ultraviolet (UV) rays from sunlight strike the skin and trigger vitamin D synthesis

US Preventive Services Task Force (USPSTF) Assessment of Magnitude of Net Benefit

The USPSTF concluded that the overall evidence on the benefits of screening for vitamin D deficiency is lacking. Therefore, the balance of benefits and harms of screening for vitamin deficiency in asymptomatic adults cannot be determined.

Summary of USPSTF Rationale

Data

Data suggest that laboratory testing for vitamin D levels has increased greatly over the last several years or longer. One report found an 80-fold increase in Medicare reimbursement volumes for vitamin D testing from 2000 to 2010.

Potential Harms

Screening may misclassify persons with a vitamin D deficiency because of the uncertainty about the cutoff for defining deficiency and the variability of available testing assays. Misclassification may result in overdiagnosis (leading to nondeficient persons receiving unnecessary treatment) or underdiagnosis (leading to deficient persons not receiving treatment).

Recommendations

No organization recommended population-based screening for vitamin D deficiency.

  • American Society for Clinical Pathology recommends against it
  • American Academy of Family Physicians supports USPSTF recommendation that there is insufficient evidence to recommend screening general population
  • Endocrine Society and American Association of Clinical Endocrinologists recommend screening in individuals at risk
    • Endocrine Society does not recommend population screening for vitamin D deficiency in individuals NOT at risk

Medicare Coverage

  • An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.
    • Effective from April 1, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, as appropriate.
  • Documentation Requirements: The patient's medical record should include but is not limited to:
    • The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
    • Relevant medical history
    • Results of pertinent tests/procedures
    • Signed and dated office visit record/operative report (Please note that all services ordered or rendered to Medicare beneficiaries must be signed.)

Bill type codes only apply to providers who bill these services to the Part A MAC. Bill type codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC

  • For claims submitted to the Part A MAC: This coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated CGS Administrators to process their claims.
  • Bill type codes only apply to providers who bill these services to the Part A MAC. Bill type codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.
  • For dates of service prior to April 1, 2010, FQHC services should be reported with bill type 73X. For dates of service on or after April 1, 2010, bill type 77X should be used to report FQHC services.

References:

Local Coverage Determinations (LCD)

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