Does Medicare Cover Vitamin D Testing? 

The human body needs all kinds of vitamins and nutrients in order to function well, but vitamin D is one of the most essential. Vitamin D helps to regulate phosphate or salt levels in the body and also controls calcium. An imbalance in either phosphate or calcium can lead to problems with bones, skin and various organs.

Where does vitamin D come from?

Vitamin D comes from a number of sources, including foods and supplements. The body also synthesizes vitamin D when exposed to sunlight. Foods like fish and liver contain a lot of vitamin D, and milk is often fortified with this vitamin.

If you live in an area that doesn’t get much sun, your doctor may recommend the use of a special light that emits ultraviolet rays which simulate those of the sun. With regular use, this may help to keep vitamin D levels up during the winter.

The dangers of low vitamin D levels

According to the National Institutes of Health, vitamin D deficiency can make you more susceptible to certain types of cancer. People with low vitamin D may also be at higher risks for autoimmune diseases, or develop conditions like rickets in children or osteomalacia in adults. These are conditions that cause bones to be soft and porous, potentially leading to weakening and an increased likelihood of fractures and breaks.

Testing for vitamin D

If you or your doctor are concerned about your vitamin D levels, you may need a vitamin D test, also known as a 25(OH)D test or 25-hydroxy vitamin D test. This test is conducted by drawing a blood sample, and it can let you and your doctor know whether you have a vitamin D deficiency.

Does Medicare cover vitamin D testing?

Medicare covers vitamin D testing as long as the test is medically necessary and is ordered by a Medicare-participating physician. The test must also take place in a clinical facility covered by Medicare benefits.

Medicare Part B, the outpatient benefit, covers 80% of the cost of vitamin D testing. This is the standard coverage rate for outpatient diagnostic services under the outpatient benefits of Part B. Medicare recipients who seek out independent testing at a clinic or lab will be responsible for the full cost of vitamin D testing even with Medicare coverage in place.

Does Medicare cover treatment for low vitamin D levels?

If you are found to have low vitamin D levels, Medicare benefits can also help to pay for treatment. As mentioned above, Medicare Part B is outpatient insurance. It covers doctor visits, clinical treatments and durable medical equipment as well as surgery in an outpatient setting. If you need to see your doctor for follow-up care based on the results of your vitamin D testing, Part B is the part of Medicare that will cover these visits.

If you are prescribed medications to treat low levels of vitamin D, Medicare insurance provides benefits for prescription medications through Medicare Part D. This is optional coverage, but it can help cover the cost of prescriptions that you purchase from a retail pharmacy.

If you are admitted to a hospital or skilled nursing facility, Medicare Part A provides benefits for inpatient care. Medicare Part A covers up to 60 days in a hospital or 20 days in a skilled nursing facility each benefit period with additional days available by paying a daily coinsurance.