This new policy will become effective on 05/28/2019.
This is a new Company Medical Policy which addresses medically necessary indications for Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing.
Main focuses in this medical policy are placed on medical necessity criteria, (including applicable ICD-10 requirements), and frequencies for coverage of Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing.
Testing of methylmalonic acid (MMA) and holo-transcobalamin (holo-TC) are also addressed in this medical policy.
When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
82607, 82608, 82746, 82747, 83090
THE FOLLOWING CODE IS USED TO REPRESENT METHYLMALONIC ACID (MMA)
THE FOLLOWING CODE IS USED TO REPRESENT HOLO-TRANSCOBALAMIN
COBALAMIN (VITAMIN B12) AND/OR FOLIC ACID TESTING (CPT CODES 82607, 82608, 82746, AND 82747) ARE MEDICALLY NECESSARY WHEN REPORTED WITH THE DIAGNOSIS CODES IN ATTACHMENT A
REPORT THE MOST APPROPRIATE DIAGNOSIS CODE IN SUPPORT OF MEDICALLY NECESSARY CRITERIA AS LISTED IN THE POLICY FOR HOMOCYSTEINE (CPT CODE 83090) AND METHYLMALONIC ACID (MMA) TESTING (CPT CODE 83921)