Notification

Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing


Notification Issue Date: 04/29/2019



Policy Attachment

Attachment to Policy # MA06.032


Attachment:A

Policy #:MA06.032

Description:ICD 10 CODES FOR MEDICALLY NECESSARY
COBALAMIN (VITAMIN B12), FOLIC ACID, AND/OR HOMOCYSTEINE TESTING (CPT CODES 82607, 82746, AND 83090)

Title:Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.



COBALAMIN (VITAMIN B12), FOLIC ACID, AND/OR HOMOCYSTEINE TESTING (CPT CODES 82607, 82746, AND 83090) ARE MEDICALLY NECESSARY WHEN REPORTED WITH THE FOLLOWING DIAGNOSIS CODES

D51.0Vitamin B12 deficiency anemia due to intrinsic factor deficiency
D51.1Vitamin B12 deficiency anemia due to selective vitamin B12 malabsorption with proteinuria
D51.2Transcobalamin II deficiency
D51.3Other dietary vitamin B12 deficiency anemia
D51.8Other vitamin B12 deficiency anemias
D51.9Vitamin B12 deficiency anemia, unspecified
D52.0Dietary folate deficiency anemia
D52.1Drug-induced folate deficiency anemia
D52.8Other folate deficiency anemias
D52.9Folate deficiency anemia, unspecified
D53.1Other megaloblastic anemias, not elsewhere classified
D53.9Nutritional anemia, unspecified
D69.6Thrombocytopenia, unspecified
D81.818Other biotin-dependent carboxylase deficiency
D81.819Biotin-dependent carboxylase deficiency, unspecified
E41Nutritional marasmus
E43Unspecified severe protein-calorie malnutrition
E45Retarded development following protein-calorie malnutrition
E46Unspecified protein-calorie malnutrition
E53.8Deficiency of other specified B group vitamins
E64.0Sequelae of protein-calorie malnutrition
E72.10Disorders of sulfur-bearing amino-acid metabolism, unspecified
E72.11Homocystinuria
E72.12Methylenetetrahydrofolate reductase deficiency
E72.19Other disorders of sulfur-bearing amino-acid metabolism
F03.90Unspecified dementia without behavioral disturbance
F03.91Unspecified dementia with behavioral disturbance
F10.20Alcohol dependence, uncomplicated
G25.70Drug induced movement disorder, unspecified
G25.71Drug induced akathisia
G25.79Other drug induced movement disorders
G25.89Other specified extrapyramidal and movement disorders
G25.9Extrapyramidal and movement disorder, unspecified
G26Extrapyramidal and movement disorders in diseases classified elsewhere
G30.0Alzheimer's disease with early onset
G30.1Alzheimer's disease with late onset
G30.8Other Alzheimer's disease
G30.9Alzheimer's disease, unspecified
G60.3Idiopathic progressive neuropathy
G60.9Hereditary and idiopathic neuropathy, unspecified
K14.0Glossitis
K14.6Glossodynia
K31.83Achlorhydria
K50.00Crohn's disease of small intestine without complications
K50.011Crohn's disease of small intestine with rectal bleeding
K50.012Crohn's disease of small intestine with intestinal obstruction
K50.013Crohn's disease of small intestine with fistula
K50.014Crohn's disease of small intestine with abscess
K50.018Crohn's disease of small intestine with other complication
K50.019Crohn's disease of small intestine with unspecified complications
K50.10Crohn's disease of large intestine without complications
K50.111Crohn's disease of large intestine with rectal bleeding
K50.112Crohn's disease of large intestine with intestinal obstruction
K50.113Crohn's disease of large intestine with fistula
K50.114Crohn's disease of large intestine with abscess
K50.118Crohn's disease of large intestine with other complication
K50.119Crohn's disease of large intestine with unspecified complications
K50.80Crohn's disease of both small and large intestine without complications
K50.811Crohn's disease of both small and large intestine with rectal bleeding
K50.812Crohn's disease of both small and large intestine with intestinal obstruction
K50.813Crohn's disease of both small and large intestine with fistula
K50.814Crohn's disease of both small and large intestine with abscess
K50.818Crohn's disease of both small and large intestine with other complication
K50.819Crohn's disease of both small and large intestine with unspecified complications
K50.90Crohn's disease, unspecified, without complications
K50.911Crohn's disease, unspecified, with rectal bleeding
K50.912Crohn's disease, unspecified, with intestinal obstruction
K50.913Crohn's disease, unspecified, with fistula
K50.914Crohn's disease, unspecified, with abscess
K50.918Crohn's disease, unspecified, with other complication
K50.919Crohn's disease, unspecified, with unspecified complications
K90.0Celiac disease
K90.1Tropical sprue
K90.2Blind loop syndrome, not elsewhere classified
K90.3Pancreatic steatorrhea
K90.49Malabsorption due to intolerance, not elsewhere classified
K90.81Whipple's disease
K90.89Other intestinal malabsorption
K90.9Intestinal malabsorption, unspecified
K91.2Postsurgical malabsorption, not elsewhere classified
R20.0Anesthesia of skin
R20.1Hypoesthesia of skin
R20.2Paresthesia of skin
R20.3Hyperesthesia
R20.8Other disturbances of skin sensation
R20.9Unspecified disturbances of skin sensation
R26.0Ataxic gait
R26.1Paralytic gait
R26.81Unsteadiness on feet
R26.89Other abnormalities of gait and mobility
R26.9Unspecified abnormalities of gait and mobility
R27.0Ataxia, unspecified
R27.8Other lack of coordination
R27.9Unspecified lack of coordination
R41.1Anterograde amnesia
R41.2Retrograde amnesia
R41.3Other amnesia
R41.82Altered mental status, unspecified
R41.9Unspecified symptoms and signs involving cognitive functions and awareness
R45.84Anhedonia
Z51.11Encounter for antineoplastic chemotherapy
Z79.3Long term (current) use of hormonal contraceptives
Z79.891Long term (current) use of opiate analgesic
Z79.899Other long term (current) drug therapy
Z86.39Personal history of other endocrine, nutritional and metabolic disease
Z98.0Intestinal bypass and anastomosis status
Z99.2Dependence on renal dialysis


Version Effective Date: 05/28/2019
Version Issued Date: 05/28/2019
Version Reissued Date: N/A

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