06/29/2011
New medical policy for routine vitamin D testing takes effect July 1
Testing for vitamin D levels has been receiving a great deal of attention in the media and medical literature over the past two years. For example, an article in U.S. News & World Report recently reported that half of all Americans have a vitamin D deficiency and that vitamin D may have a role in preventing diseases such as diabetes, heart disease and cancer. As a result of this increased attention, we've seen a four-fold increase in related claims costs for 2010.
Although there is evidence that vitamin D plays an essential role in promoting bone growth and maintenance, there's considerable uncertainty about both the reliability and the usefulness of the test for other indications.
Responding to this uncertainty, our Medical Policy Team evaluated the scientific evidence related to vitamin D testing and found the following:
- Toxic, deficient and optimal vitamin D serum levels haven't been defined.
- The serum tests that measure levels of vitamin D aren't standardized, so tests from different labs are different from one another.
- There's no evidence to show that testing leads to better treatment plans or improved health outcomes for patients who don't have signs of diseases or conditions that are specifically associated with a vitamin D deficiency.
As a result of examining these issues, we'll implement a new vitamin D testing policy effective July 1, 2011. This policy states that vitamin D testing isn't medically necessary for routine screening purposes. In most cases, such claims will be denied as a provider write-off.
This policy applies to group, Individual and Regence MedAdvantage products unless an applicable national coverage determination (NCD) or a local coverage determination (LCD) specific to vitamin D testing is implemented. The policy doesn't apply to Federal Employee Program members.
Regence is an established leader in evidence-based medical policy formulation and technology assessment. New and expensive medical technologies are among the biggest drivers of escalating health care costs. The Regence medical policy review process ensures that we review these technologies objectively and cover effective treatments.
If you have questions about this new policy, please contact your Regence sales executive.
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