Vitamin D, 25-Hydroxy (CPT 82306)
Medicare Rate vs. Lab Charges
Medicare pays $29.04 for this test. Labs commonly charge $65.00–$298.00. That's a 124%–926% markup above what Medicare pays.
What This Test Is
This test measures 25-hydroxyvitamin D, the form that indicates your vitamin D status. Low vitamin D is linked to bone health, immune function, and mood. Doctors order this to screen for deficiency, especially in older adults, those with limited sun exposure, or those with bone or autoimmune conditions.
Medicare Rate vs. Lab Charges
| Medicare Allowable Rate | $29.04 |
| Typical Lab Charge Range | $65.00–$298.00 |
| Average Markup Above Medicare | 124%–926% |
Does Medicare Cover This Test?
Yes, Medicare Part B covers vitamin D testing for patients with symptoms of deficiency, bone disease, or malabsorption. Routine screening may have limitations.
Common Reasons for Denial
- Screening in asymptomatic patient without bone disease or deficiency symptoms
- Tested too frequently (routine annual screening may not be covered)
- No diagnosis code documenting reason for test
- Patient taking vitamin D supplements and asymptomatic
- Duplicate test within 6-12 months without symptom change
What To Do If You're Overcharged
If you received a lab bill that seems unusually high compared to Medicare rates:
- Check your Explanation of Benefits (EOB) from Medicare or your insurance to see what should have been paid.
- Request an itemized bill from the lab showing all charges.
- Compare to GougeStop rates for your area to see if the charge is reasonable.
- Contact the lab's billing department to dispute erroneous charges or negotiate a lower rate.
- File an appeal with Medicare if a claim was incorrectly denied.
Frequently Asked Questions
A: If you have osteoporosis, bone pain, limited sun exposure, or GI conditions affecting absorption, testing is reasonable. Otherwise, routine screening may not be covered.
A: Yes, if medically necessary. Routine screening in healthy, asymptomatic individuals may not be covered. Check with your doctor about medical justification.
A: It's a more specialized test, so the Medicare rate is higher ($29). Labs still mark it up 2-10x, but absolute cost is lower than many basic panels.