rcbaker200
New member
- Joined
- Sep 7, 2009
- Messages
- 5
- Country
- US
- State
- NJ
- City
- Cherry Hill
Re: cost of Vitamin D test
Out of the 1700 25-hydroxy vitamin D tests, every one has been paid for by insurance, including medicare and medicaide. I know that because if it didn't get paid for, the patient would complain to me. Also I have several friends who are on medicare, and they get the blood test paid for 100%, just like any other blood test is paid for. I also have patients on medicaide only, and they get it paid for. Also Horizon Blue Shield of NJ has always paid for my tests.
Now every blood test has to have a diagnosis code associated with it. If a patient is known to have a low vitamin D level, I put 268.9.
If the patient has osteoporosis, I put 733.00
Osteopenia - 733.90.
If none of these apply, if the patient has had muscle pain or inflammation of the muscle, I put 729.1, myositis. (Vitamin D insufficiency has been proven to be associated with muscle pain or soreness.)
ALS is 335.20. However I cannot take it for granted that medicare will accept the need for a level just with that code. They haven't read the latest research.
The full retail price of the 25-hydroxyvitamin D level is $200. But what do the insurance companies pay the labs? In most cases, but not all, they have a contract with the lab and knock down the price to about $50. I mention this so noone will feel guilty that they are costing their insurance company a great deal of money.
An additional note - I have run across situations about a dozen times in 5 years where a physician will tell his patient "Your insurance won't pay for that test." It is an incorrect statement usually told to the patients because the doctor has no clue as to the prevelance and importance of vitamin D deficiency. Also there is always a possibility that the person who answers the phone for an insurance company may not give the correct answer.
As far as repeat studies, initially I sometimes got a repeat in 3 months. Other doctors I have worked with have gotten this too, and again, it has always been paid for (with the repeat test, since a low level has already been diagnosed, the 268.9 code can be used). Now that I have the experience with levels, I rarely have need to repeat a level before 6 months. Once it's stabale at an idieal level, it could be changed to every 12 months.
So there is no misunderstanding, let me repeat:
MEDICARE AND MEDICAIDE AND EVERY OTHER INSURANCE COMPANY HAS ALWAYS PAID FOR A 25-HYDROXY VITAMIN D LEVEL. Final note - it is the total that you want, the breakdown between D2 and D3 doesn't matter. And DO NOT get the 1-25-hydroxy vitamin D. It's a different test and is worthless in determining if Vitamin D is deficiency. About once a year I have seen a laboratory make a mistake and do the wrong test.
Out of the 1700 25-hydroxy vitamin D tests, every one has been paid for by insurance, including medicare and medicaide. I know that because if it didn't get paid for, the patient would complain to me. Also I have several friends who are on medicare, and they get the blood test paid for 100%, just like any other blood test is paid for. I also have patients on medicaide only, and they get it paid for. Also Horizon Blue Shield of NJ has always paid for my tests.
Now every blood test has to have a diagnosis code associated with it. If a patient is known to have a low vitamin D level, I put 268.9.
If the patient has osteoporosis, I put 733.00
Osteopenia - 733.90.
If none of these apply, if the patient has had muscle pain or inflammation of the muscle, I put 729.1, myositis. (Vitamin D insufficiency has been proven to be associated with muscle pain or soreness.)
ALS is 335.20. However I cannot take it for granted that medicare will accept the need for a level just with that code. They haven't read the latest research.
The full retail price of the 25-hydroxyvitamin D level is $200. But what do the insurance companies pay the labs? In most cases, but not all, they have a contract with the lab and knock down the price to about $50. I mention this so noone will feel guilty that they are costing their insurance company a great deal of money.
An additional note - I have run across situations about a dozen times in 5 years where a physician will tell his patient "Your insurance won't pay for that test." It is an incorrect statement usually told to the patients because the doctor has no clue as to the prevelance and importance of vitamin D deficiency. Also there is always a possibility that the person who answers the phone for an insurance company may not give the correct answer.
As far as repeat studies, initially I sometimes got a repeat in 3 months. Other doctors I have worked with have gotten this too, and again, it has always been paid for (with the repeat test, since a low level has already been diagnosed, the 268.9 code can be used). Now that I have the experience with levels, I rarely have need to repeat a level before 6 months. Once it's stabale at an idieal level, it could be changed to every 12 months.
So there is no misunderstanding, let me repeat:
MEDICARE AND MEDICAIDE AND EVERY OTHER INSURANCE COMPANY HAS ALWAYS PAID FOR A 25-HYDROXY VITAMIN D LEVEL. Final note - it is the total that you want, the breakdown between D2 and D3 doesn't matter. And DO NOT get the 1-25-hydroxy vitamin D. It's a different test and is worthless in determining if Vitamin D is deficiency. About once a year I have seen a laboratory make a mistake and do the wrong test.
