LCD Reference Article Billing and Coding Article

Billing and Coding: Vitamin B12 Injections

A57755

Expand All | Collapse All
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57755
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Vitamin B12 Injections
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
04/01/2024
Revision Ending Date
N/A
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33967 Vitamin B12 Injections. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidelines

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier. 

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. Progress notes and laboratory test results indicating present or past values of serum B12 as well as supporting the treatment for the identified diagnosis(es) need to be maintained and made available upon request in the event a review is required.
  5. A serum B12 level is not required if vitamin B12 is administered in conjunction with pemetrexed or pralatrexate. The medical record should reflect the patient is being treated with pemetrexed or pralatrexate. 

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

CPT/HCPCS Codes

Please accept the License to see the codes.

N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(44 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for HCPCS codes: J3420 and J3425.

Group 1 Codes
Code Description
D51.0 Vitamin B12 deficiency anemia due to intrinsic factor deficiency
D51.1 Vitamin B12 deficiency anemia due to selective vitamin B12 malabsorption with proteinuria
D51.2 Transcobalamin II deficiency
D51.3 Other dietary vitamin B12 deficiency anemia
D51.8 Other vitamin B12 deficiency anemias
D51.9 Vitamin B12 deficiency anemia, unspecified
D52.0 Dietary folate deficiency anemia
D52.1 Drug-induced folate deficiency anemia
D52.8 Other folate deficiency anemias
D52.9 Folate deficiency anemia, unspecified
D53.1 Other megaloblastic anemias, not elsewhere classified
D53.9 Nutritional anemia, unspecified
D81.818 Other biotin-dependent carboxylase deficiency
D81.819 Biotin-dependent carboxylase deficiency, unspecified
E40 Kwashiorkor
E41 Nutritional marasmus
E42 Marasmic kwashiorkor
E44.1 Mild protein-calorie malnutrition
E45 Retarded development following protein-calorie malnutrition
E46 Unspecified protein-calorie malnutrition
E53.8 Deficiency of other specified B group vitamins
E64.0 Sequelae of protein-calorie malnutrition
G32.0 Subacute combined degeneration of spinal cord in diseases classified elsewhere
K29.30 Chronic superficial gastritis without bleeding
K29.40 Chronic atrophic gastritis without bleeding
K29.50 Unspecified chronic gastritis without bleeding
K86.0 Alcohol-induced chronic pancreatitis
K86.1 Other chronic pancreatitis
K90.0 Celiac disease
K90.1 Tropical sprue
K90.2 Blind loop syndrome, not elsewhere classified
K90.3 Pancreatic steatorrhea
K90.41 Non-celiac gluten sensitivity
K90.49 Malabsorption due to intolerance, not elsewhere classified
K90.821 Short bowel syndrome with colon in continuity
K90.822 Short bowel syndrome without colon in continuity
K90.83 Intestinal failure
K90.89 Other intestinal malabsorption
K90.9 Intestinal malabsorption, unspecified
K91.1 Postgastric surgery syndromes
K91.2 Postsurgical malabsorption, not elsewhere classified
T50.995A* Adverse effect of other drugs, medicaments and biological substances, initial encounter
T50.995D* Adverse effect of other drugs, medicaments and biological substances, subsequent encounter
T50.995S* Adverse effect of other drugs, medicaments and biological substances, sequela
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

Note:* ICD-10-CM codes T50.995A, T50.995D, and T50.995S apply to administration of Vitamin B12 as adjunct to Alimta®.

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

Please accept the License to see the codes.

N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
04/01/2024 R3

Article revised and published on 04/04/2024 effective for dates of service on and after 04/01/2024 to reflect the April Quarterly CPT/HCPCS Code Update. For the following HCPCS code either the short description and/or the long description was changed: J3425. Depending on which description is used in this article, there may not be any change in how the code displays in the document.

01/01/2024 R2

Article revised and published on 01/25/2024 effective for dates of service on and after 01/01/2024 to reflect the Annual HCPCS/CPT Code Updates. The following HCPCS code has been added to the Article: J3425 to Group 1 CPT/HCPCS Codes. Added Social Security Act reference [Title XVIII, Section 1833(e)].

10/01/2023 R1

Article revised and published on 10/26/2023 effective for dates of service on and after 10/01/2023 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM codes have been added to the article: K90.821, K90.822, and K90.83 in Group 1 Codes. Minor formatting changes have been made throughout the article.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33967 - Vitamin B12 Injections
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
03/27/2024 04/01/2024 - N/A Currently in Effect You are here
01/19/2024 01/01/2024 - 03/31/2024 Superseded View
10/20/2023 10/01/2023 - 12/31/2023 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A