Why does Medicare not cover a Vitamin D-3 blood test?

In My Humble Opinion
21

There are times when treating the numbers makes sense because it is fairly well established what different numbers mean clinically. Such is not the case here.

Synopsis of the most recent guidelines here. Click each question for their conclusion. Basic theme repeated is

  • “In this population, 25(OH)D levels that provide outcome-specific benefits have not been established in clinical trials.

  • The panel suggests against (a) routine screening for a 25(OH)D level to guide decision-making (i.e., vitamin D vs no vitamin D) and (b) routine follow-up testing for 25(OH)D level to guide vitamin D dosing.”

More detail than most would want here:

https://academic.oup.com/edrv/article/45/5/625/7659127

It is very unclear if the association of low vitamin D stores (as reflected by 25OH Vitamin D levels) is cause or effect. The benefits of supplementation are solidly seen only in a few specific circumstances (e.g. infirm elderly at high risk of fractures when given with a calcium supplement as well) and otherwise are mostly “potential” benefits.

Screening broadly adds up as a significant public health expense without evidence that it improves health outcomes. A recommendation for screening generally has to pass the other way, defined benefits that outweigh the cost.

Supplementation of an RDA’s worth (fortified food or otherwise) OTOH is low cost low risk option that even possible benefit is, to the expert panel, worth doing.

Specific conditions and circumstances are exceptions but not the rule.

22

Yes it will. Put me into the toxic range after a while.

23

I’ll throw in my anecdote: about 4-5 years ago, on a company health plan, my doctor looked at my bloodwork and recommended OTC vitamin D. My feeling was that testing for this was due to some new guidance, as it hadn’t been tested before as far as I knew

I started taking a D supplement every day. Six months later, fresh bloodwork, and my results were way high, beyond the little bar chart they provide. My doctor said cut way back.

Was that level “toxic”? I can’t say, and she didn’t use that term. It could have been as simple as she wanted me to be within the expected range.

I’ve been on 2x a week for several years, and now that Medicare doesn’t automatically cover it, we don’t test for it, so I guess it is alright.

24

We heard back from his doctor today, she thinks it might be an error in the way the lab coded the test, so she’s going to talk to them about it. She seems to believe it is a routine test that should have been covered.