Summary & Overview
CPT 82306: Laboratory Test for Vitamin D, 25 Hydroxy
CPT code 82306 represents the laboratory analysis of Vitamin D; 25 hydroxy, a critical test for evaluating vitamin D levels in patients. This procedure is essential for diagnosing and monitoring conditions such as osteoporosis, metabolic bone disorders, and other health issues linked to vitamin D deficiency. The test is performed in independent laboratories and is a standard component of preventive and diagnostic care across the United States.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, provide coverage for this laboratory service. The publication offers a comprehensive overview of payer policies, clinical indications, and billing practices associated with CPT code 82306. Readers will gain insights into relevant modifiers, associated taxonomies, and ICD-10 diagnoses commonly linked to this test, such as various forms of tuberculosis and related respiratory and neurological conditions. Additionally, the article highlights related CPT codes for laboratory tests frequently ordered alongside vitamin D assessment, including calcium, creatinine, thyroid stimulating hormone, and comprehensive metabolic panels.
This summary equips healthcare professionals, billing specialists, and policy analysts with the latest information on coverage, coding, and clinical context for vitamin D testing, supporting informed decision-making and compliance with payer requirements.
CPT Code Overview
CPT code 82306 is used to report laboratory testing for Vitamin D; 25 hydroxy, which includes fraction(s) if performed. This test is commonly ordered to assess a patient's vitamin D status, an important factor in bone health and overall metabolic function. The service type is Laboratory, and the typical site of service is an Independent Laboratory (Place of Service 81). This code is widely utilized in clinical practice to support diagnosis and management of conditions related to vitamin D deficiency or abnormal metabolism.
Clinical & Coding Specifications
Clinical Context
A patient presents to a family medicine or internal medicine clinic with symptoms suggestive of vitamin D deficiency, such as fatigue, bone pain, or muscle weakness. The provider orders laboratory testing to assess vitamin D status, specifically the 25-hydroxy vitamin D level, which is the most reliable marker for vitamin D sufficiency. The blood sample is collected and sent to an independent laboratory (Place of Service 81) for analysis. The laboratory performs the assay for CPT code 82306 to measure 25-hydroxy vitamin D, including fractions if performed. Results are reported back to the provider, who interprets them in the context of the patient's clinical presentation and any underlying conditions, such as tuberculosis or other relevant diagnoses.
Coding Specifications
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Modifiers:
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Modifier
26: Indicates the professional component of the laboratory service, typically used when the provider interprets the results but does not perform the technical portion. -
Modifier
90: Used when the laboratory test is performed by a reference (outside) laboratory, not the laboratory that received the specimen.
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Provider Taxonomies:
Taxonomy Code Specialty Name 291U00000XClinical Medical Laboratory 207Q00000XFamily Medicine Physician 207R00000XInternal Medicine Physician -
Specialties Represented:
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Clinical Medical Laboratory: Performs laboratory testing and analysis.
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Family Medicine Physician: Orders and interprets laboratory tests for general medical conditions.
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Internal Medicine Physician: Orders and interprets laboratory tests for adult medical conditions.
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Related Diagnoses
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A15.0- Tuberculosis of lung- Vitamin D status may be evaluated in patients with pulmonary tuberculosis due to its role in immune function.
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A15.4- Tuberculosis of intrathoracic lymph nodes- Assessment of vitamin D can be relevant in tuberculosis affecting lymphatic structures within the thorax.
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A15.5- Tuberculosis of larynx, trachea and bronchus- Vitamin D testing may be considered in patients with respiratory tract tuberculosis.
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A15.6- Tuberculous pleurisy- Vitamin D levels are checked in pleural tuberculosis as part of immune and nutritional assessment.
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A15.7- Primary respiratory tuberculosis- Initial tuberculosis infection may prompt evaluation of vitamin D status.
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A15.8- Other respiratory tuberculosis- Vitamin D testing is relevant in less common forms of respiratory tuberculosis.
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A17.0- Tuberculous meningitis- Neurological tuberculosis cases may include vitamin D assessment due to its immunomodulatory effects.
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A17.1- Meningeal tuberculoma- Vitamin D testing may be performed in patients with tuberculomas affecting the meninges.
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A17.81- Tuberculoma of brain and spinal cord- Assessment of vitamin D is relevant in central nervous system tuberculosis.
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A17.82- Tuberculous meningoencephalitis- Vitamin D status is evaluated in patients with meningoencephalitis caused by tuberculosis.
Related CPT Codes
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82310- Calcium; total- Often ordered alongside
82306to assess calcium metabolism, which is closely linked to vitamin D status.
- Often ordered alongside
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82565- Creatinine; blood- Used to evaluate kidney function, which can affect vitamin D metabolism and is relevant in patients with chronic conditions.
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84443- Thyroid stimulating hormone (TSH)- Assesses thyroid function, which may be evaluated in patients with nonspecific symptoms or metabolic concerns.
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80053- Comprehensive metabolic panel- Provides a broad overview of metabolic health, including electrolytes, kidney and liver function, and may be ordered with
82306for a comprehensive assessment.
- Provides a broad overview of metabolic health, including electrolytes, kidney and liver function, and may be ordered with
Common Clinical Workflow:
82306is frequently ordered with82310and80053to evaluate bone and metabolic health.82565and84443may be included to assess related organ systems or rule out other causes of symptoms.
National Reimbursement Benchmarks
National mean rates for CPT code 82306 show that Aetna and Cigna reimburse at higher levels, with mean rates of $35.26 and $33.64, respectively. The BUCA (average commercial) mean rate is $29.39, which is notably higher than UnitedHealth Group ($25.40) and Blue Cross Blue Shield ($25.83). Medicare rates are not available in the input for comparison.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Cigna exhibits the widest spread ($41.00 - $16.50 = $24.50), indicating significant variability in reimbursement. UnitedHealth Group has the tightest range ($29.00 - $13.00 = $16.00), suggesting more consistent rates. Aetna and BUCA also show moderate dispersion, while Blue Cross Blue Shield falls in between.
The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.
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