CPT code 82306, cpt 82306, 82306 cpt code, 82306

(2022) CPT Code 82306 – Description, Guidelines, Modifiers, Reimbursement & Examples

CPT code 82306 relates to Vitamin D lab Assay Testing, and it is reimbursable under Medicare if it fulfils the criteria of indications under LCD (Local Coverage Determination).

It is not performed as a routine screening as 42 CFR 410.32(a). Instead, the test is conducted to determine the ingredients and the quality of Vitamin D.

CPT code 82306 is a vitamin D blood test, and it is performed to measure the level of 25 (OH) D in the subject’s blood. If the vitamin D level is not regular, it may cause nutritional disorders, organ damage, and bone disorders. And other medical-related problems may develop in the subject (patient).

CPT Code 82306 Description

Vitamin D is an essential nutrient in the human body and is required for healthy teeth and bones.

CPT code 82306 Description
CPT Code 82306 Description

Vitamin D has two main types, including vitamin D2 and vitamin D3.

  • Vitamin D2 is found in milk, cereals, and dairy products.
  • Vitamin D3 is produced by the human body when exposed to the sun. Moreover, vitamin D3 also occurs in foods like eggs and fish (tuna, mackerel, and salmon).
  • Vitamin D2 and D3 change into vitamin D in 25 hydroxyvitamin D or 25 (OH) D.

The CPT 82306 tests the amount of vitamin D in a person’s blood, and it is only then that the physician needs to know its quantity in the blood while diagnosing.

What Is CPT Code 82306 Used For?

Vitamin D assays to check the levels of vitamin D in the blood to screen for bone disorders, asthma, autoimmune diseases, chronic illness, and psoriasis.

The CPT 82306 (vitamin D assay) is recommended if the patient has the following disorders in their body.

  • Soft bones
  • weak bones
  • malformation of bones
  • fractures

Vitamin D test is administered if the patient has a deficiency in their bloodstream. The test may be ordered if the patient or the subject is showing vitamin D deficiency symptoms. 

Vitamin D deficiency may also lead to liver or kidney malfunctions.

Some of the causes of vitamin D deficiencies are less exposure to sunlight, gastric bypass surgery, obesity, darker complexion, geriatric patients, difficulty in absorbing fat in the diet, osteoporosis (bone disorder).

CPT 82306 Vitamin D Blood Test

Healthcare related personnel takes a blood sample from the subject or patient’s vein with a small needle and collect blood in a small vial or test tube. Venipuncture can also be carried out by the third-party laboratory, as per agreement with the physician.

Vitamin D deficiency may be treated in different ways, and one of those ways may include the use of supplements and/or the use of vitamin D-rich foods.

If CPT 82306 Vitamin D blood test shows an excess of Vitamin D in the bloodstream, it is in excess due to excessive use of Vitamin D pills. An excessive amount of Vitamin D causes problems in blood vessels.

Billing Guidelines For CPT Code 82306

The CPT 82306 Vitamin D blood test is performed explicitly after the physician has confirmed that the patient needs this test. They expressly and emphatically advise this test with proof of the malfunctions of the patient’s body and ensure that everything goes well in this context.

Human skin synthesizes the hormone vitamin D, and the kidney metabolizes it to convert it into calcitriol. 

If it is more than usual, it may cause hypercalcemia; on the other hand, if it is less than average, it may cause bone issues and the malfunction of organs like kidneys and liver. Unfortunately, the reimbursement of these services is available only with Medicare.

CPT code 82306 is also used for routine screening and can be ordered four times per year.

Medicare provides vitamin D testing reimbursement, but it allows a screening process for the purpose so that more than one vitamin D test may be performed. 

Micronutrients are also measured in the process, and the deficiencies are noted down, which, in many cases, are due to the wrong selection of foods. 

After diagnosing the issues and measuring the minerals, vitamin D, and other materials in blood, the health care official may advise changes in food intake.

Moreover, Medicare covers only clinical and laboratory studies, which are vital for the diagnosis and treatment of the illness or the problem. As this is only a vitamin D deficiency, healthcare officials can devise easy ways to find health-giving solutions and make positive changes in the patient’s lifestyle.

Limitations

Statute (Social Security Act 1861 (nn)) governs screening tests for Medicare clients, and vitamin or micronutrient testing does not appear to have been employed for routine screening.

After testing for CPT code 82306, the other related tests are also performed to reach the root cause of the issue and find further complexities that disturb the patient’s health. Additional testing can find the exact situation and position where the patient stands. After consultation with the health care official, the patient may go for further testing and then for other treatment.

Keep in mind that the uncovered tests are functional intracellular analysis (CPT 84999), selenium (CPT 84255), and total antioxidant function (CPT 84999).

Some of the test-related and necessary blood tests include High-Sensitivity C – Reactive Protein and Lipoprotein-associated phospholipase A2 (Lp – PLA2); Carnitine, 25-OH Vitamin D-3, Vitamin B – 12, Homocysteine, Vitamin B – 2, Vitamin B – 1, Vitamin E, Fibrinogen, Vitamin – K; Vitamin – A; and Ascorbic acid, Folic Acid (Serum) and Vitamin B – 6.

For billing of CPT code 82306, it is required to have CLIA Certification. Because among other assay screening tests, CPT 82306 is also CLIA certified test. It must be represented with the help of a modifier. 

As Medicare is the only covered company, it is necessary to make sure that the service you are applying for should be reasonable and to the point. 

The test service that the physician has devised must follow the criteria set forth by Medicare.

The proposed LCD for service should be under Section 1862(a)(1)(A), and the service must be safe and effective in all circumstances.

The service should be nonexperimental or investigational (except the routine cost of qualifying clinical trial services on or after September 19, 2000, as per the requirements of NCD).

  • Appropriate in terms of duration and frequency.
  • Performed according to medical standards.
  • Served as per the requirements of the subject or patient.
  • Furnished by specialty.

CPT Code 82306 Reimbursement

The reimbursement for the CPT 82306 requires the coder to find the Revenue Codes that the contractors provide to help report this service. 

These revenue codes are advisory as their absence in the report does not affect billing or reimbursement.

The test fee for CPT 82306 varies in different states. Government Payer, i.e., Medicare, makes reimbursements at the fixed amount. 

The test fee for Medicare is $40.70. Other commercial payers, e.g., Aetna, makes reimbursements for CPT 82306 at the rate of $18.32. 

Venipuncture performed by the physician/ nurse or by other third-party laboratory services is inclusive of the main service (CPT 82306).

Modifier

CPT code 82306 is solely required to have CLIA Certification. Thus, CPT 82306 may be billed with the modifier QW to represent the CLIA certification.

CPT Code 82306 Example

If a patient is advised the CPT 84591 and CPT 82306 at the same time, the physician and the coder must keep in mind that these two CPT codes are not paid when billed together, so the coder should ensure that they are not billed together, and their bills must be claimed separately. 

This will allow the physician or the laboratory to receive their due reimbursement without going through the auditing process.

Thus, the CPT code 82306 for vitamin D has its uses, and the ways of using it are a little bit different as the reimbursing is available only at Medicare.

It is, therefore, advisable to get this test performed along with all the other tests with precaution as many other tests may follow this test considering the implications of the deficiency or excess amount of vitamin D in the bloodstream.

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