Does Medicare Cover Vitamin D Testing?
- Vitamin D is essential to good health, and many doctors include a screening with routine blood work. Explore Medicare coverage criteria for vitamin D testing.
Adequate vitamin D is essential to good health, supporting lung function, immune health and strong bones, and many doctors now include a vitamin D screening with other routine blood work. Because maintaining healthy levels of this nutrient is even more important as you age, Medicare covers vitamin D testing for beneficiaries who may be at risk for a deficiency. In this article, you'll find an overview of vitamin D and what it does, as well as coverage criteria for vitamin D testing under Original Medicare and Medicare Advantage.
Does Medicare Cover Vitamin D Testing?
Medicare Part B and Medicare Advantage plans cover a wide range of clinical laboratory tests, including blood work, if your physician orders them. This may include vitamin D screenings, particularly for populations that have an increased risk of a deficiency.
However, because a vitamin D screening isn’t typically performed with routine blood work, your doctor may need to prove it’s medically necessary before it's considered reimbursable. This may require supporting documentation such as proof of a medical condition known to cause vitamin D deficiency or a detailed list of symptoms that may indicate a deficiency. This will be documented with an ICD 10 code for vitamin D deficiency.
If the vitamin D screening is approved, testing must be done in a Medicare-approved laboratory. Original Medicare typically pays 20% of the cost as long as the beneficiary has met their applicable deductible. Medicare Advantage Plans may provide additional coverage, depending on the individual plan and carrier.
When a chronic deficiency is suspected, Medicare may cover repeat blood tests to monitor the condition. If your doctor suspects an underlying condition may be causing the deficiency, Medicare may approve additional screenings to assist in the diagnosis. The IDC 10 Code for Vitamin D deficiency is 55.9. Yearly limits may apply in these instances.
Why Is Vitamin D Important?
Vitamin D is vital to maintaining good health at all ages. It plays an important role in regulating various cellular functions to support healthy muscles, bones and brain cells. Vitamin D is also responsible for:
- Reducing inflammation
- Promoting immune function
- Facilitating calcium absorption
- Protecting against osteoporosis
- Modulating cell growth
Vitamin D may also reduce the risk of falls in older individuals and can play a role in disease prevention, guarding against diabetes, heart disease and certain types of cancer.
How Do You Get Vitamin D?
Vitamin D occurs naturally in certain foods, including fatty fish, egg yolks, beef liver and cheese. Some foods purchased commercially in the United States, including milk, cereal and orange juice, may also be fortified with vitamin D. In addition, vitamin D may be produced in the human body when the skin is directly exposed to sunlight.
Because some individuals may be unable to maintain adequate levels of vitamin D through dietary means and exposure to sunlight, many physicians recommend a once-daily multivitamin supplement.
What Can Cause a Vitamin D Deficiency?
Vitamin deficiency can occur for a number of reasons. Risk factors that can affect the body’s ability to produce or absorb adequate vitamin D include:
- Advanced age
- Pregnancy or breastfeeding
- Darker skin pigmentation
- Lack of sun exposure
- Medical conditions that limit fat absorption, including liver disease, ulcerative colitis and cystic fibrosis
Certain medications, such as steroids, anti-seizure drugs and stimulant laxatives may also prevent your body from effectively absorbing and processing vitamin D.
What Are the Symptoms of Vitamin D Deficiency?
Without a blood test, vitamin D deficiency may go undetected. However, the following symptoms may indicate low levels of this vitamin:
- Hair loss
- Low mood
- Muscle aches
- Low back pain
- Slow-to-heal wounds
- Frequent bouts of sickness or infection
If you’re exhibiting one or more of these symptoms, your doctor may recommend a screening for vitamin D levels.
Why Are Older Adults at Risk for Vitamin D Deficiency?
Vitamin D is produced naturally when the human body is exposed to sunlight. However, the skin’s ability to synthesize vitamin D declines with age, leaving older adults more at risk for a deficiency. Older adults also tend to get less vitamin D through natural food sources and may spend less time outdoors, leading to lower levels of the nutrient.
How Is Vitamin D Deficiency Treated?
The prescribed treatment for low vitamin D levels depends on your age, the severity of the deficiency and whether your doctor suspects an underlying cause, such as a malabsorption disease. In most cases, your physician will suggest OTC or prescription-based supplements of vitamin D2 or D3, which can help raise the level of vitamin D in your body. After you’ve reached a satisfactory level, usually after about six to eight weeks of treatment, your doctor may then lower the recommended dosage to a maintenance dose.
Can You Take Too Much Vitamin D?
Although vitamin D is generally considered safe when supplements are taken in appropriate doses, too much vitamin D can lead to toxicity. Individuals who take more than 4,000 IU daily may experience the following side effects:
- Weight loss
- Decreased appetite
- Nausea or vomiting
More serious consequences of ingesting too much supplemental vitamin D are kidney stones, kidney damage and heart rhythm problems.
Treatment typically involves stopping all supplemental vitamin D intake and limiting dietary calcium. Intravenous fluids and certain medications may also help return vitamin D levels to within normal limits.
To prevent vitamin D toxicity, individuals who are taking high levels of supplements should have their blood monitored regularly so they can adjust their dose accordingly.
Does Medicare Pay for Vitamin D Supplements?
If your physician recommends prescription vitamin D supplements to treat a diagnosed deficiency, they may be covered under a Part D prescription drug plan or a Medicare Advantage Plan that includes prescription drug benefits. Because Part D and MA plans are administered through private companies, coverage terms such as cost depend on your policy’s unique formulary.
Some Medicare Advantage Plans may also offer additional benefits, including an allowance for OTC products such as nonprescription vitamin D supplements.