Vitamin D Testing - (0526) — MM 0526 | CIGNA Coverage Update

Cigna modified MM 0526 for Vitamin D testing, effective October 16, 2025. Here's what billing teams need to know before claims start denying.

Cigna Healthcare updated its Vitamin D testing coverage policy under MM 0526, affecting three CPT codes — 82306, 82652, and 0038U — used to bill serum Vitamin D testing across hundreds of covered diagnoses. The update changes the medical necessity criteria that govern when these tests are considered reimbursable. If your team bills Vitamin D testing for Cigna members, review your ICD-10 pairing practices now — this is not a policy you want to catch up with after the effective date of October 16, 2025.

Quick-Reference Table

Cigna Vitamin D Testing Coverage Criteria and Medical Necessity Requirements 2025

The Cigna Healthcare Vitamin D testing coverage policy under MM 0526 covers three tests when specific medical necessity criteria are met. Those three codes are CPT 82306 (25-hydroxy Vitamin D), CPT 82652 (1,25-dihydroxy Vitamin D), and CPT 0038U (Vitamin D, 25-hydroxy D2 and D3 by LC-MS/MS, serum microsample, quantitative).

The distinction between 82306 and 82652 matters more than most billing teams realize. CPT 82306 measures 25-hydroxy Vitamin D — the standard test for overall Vitamin D status. CPT 82652 measures 1,25-dihydroxy Vitamin D, the active form. The active form test has a narrower clinical use case. Billing 82652 when 82306 was the appropriate test is a fast path to a claim denial under this policy.

CPT 0038U is a proprietary lab test (PLA code) for Vitamin D testing by liquid chromatography-tandem mass spectrometry on a serum microsample. It's covered under the same medical necessity framework as 82306. If your lab bills this code, confirm your ICD-10 pairings meet the same criteria required for 82306.

All three codes are considered medically necessary when the patient's diagnosis falls within the covered ICD-10 code set. That set is extensive — 486 ICD-10-CM codes in total. It spans tuberculosis (A15–A19 ranges), hepatobiliary and pancreatic malignancies, lymphomas, and far beyond. The breadth of the list is actually useful — but it also means your team needs to match the right code precisely. A diagnosis that's one character off can trigger a denial.

Prior authorization requirements for this policy are not explicitly stated in the MM 0526 documentation as a universal requirement. That said, some Cigna plan types impose prior authorization at the plan level, separate from the coverage policy itself. If your patient population includes a significant share of Cigna fully-insured commercial members, check plan-level requirements before assuming PA isn't needed.

Coverage Indications at a Glance

Cigna Vitamin D Testing Billing Guidelines and Action Items 2025

The real risk with MM 0526 is volume. Vitamin D testing is one of the most frequently billed lab panels in outpatient settings. Small errors in ICD-10 selection at scale become big write-offs fast. Here's what to do before October 16, 2025.

CPT, HCPCS, and ICD-10 Codes for Vitamin D Testing Under MM 0526

Covered CPT Codes (When Medical Necessity Criteria Are Met)

Key ICD-10-CM Diagnosis Codes

The full covered list includes 486 ICD-10-CM codes. Below are the codes provided in the MM 0526 policy data. Verify your complete list against the full policy document.

The full covered ICD-10 list under MM 0526 contains 486 codes. The codes above represent the diagnoses published in the available policy data. Pull the complete code list from the full MM 0526 policy document before finalizing your charge capture updates.