Coverage for vitamin B-12 injections is determined according to individual or group customer benefits. Payment may be made for vitamin B-12 (J3420) injections only if the patient's diagnosis or condition is one of the following:
- Anemias
Pernicious anemia (281.0) (Addisonian anemia, Biermier's anemia)
Macrocytic anemias (281.9)
Fish tapeworm anemia (123.4)
Megaloblastic anemia (281.3, 281.9)
Other vitamin B-12 deficiency anemia (281.1)
- Gastrointestinal disorders
Malabsorption syndromes such as sprue (579.1) and idiopathic steatorrhea (579.0)
Regional enteritis and Crohn's disease (555.0-555.9)
Other malabsorption syndromes (270.7, 579.3, 579.8, 579.9)
Surgical or mechanical disorders resulting from resection of the small intestine (e.g., intestinal strictures) (536.9, 557.1, 560.9, 564.2, 564.4, 564.9, 751.1-751.3)
Intestinal anastomosis (569.89, 997.4-997.5)
Blind loop syndrome (579.2) and gastrectomy
States associated with decreased production of intrinsic factor
- Neuropathies
Posterolateral sclerosis (266.2)
Neuropathies associated with pernicious anemia (Addisonian anemia Biermier's anemia)
The acute phase or acute exacerbation of a neuropathy due to malnutrition or alcoholism, alcohol amnestic syndrome (291.1, 337.1, 337.9, 357.4, 357.5)
Nutritional optic neuropathy (377.33)
Toxic optic neuropathy (377.34)
- Dementias secondary to Vitamin B-12 deficiency (294.10-294.11)
- Methylmalonic aciduria (791.9)
- Homocystinuria (270.4)
- Retrobulbar neuritis associated with heavy smoking (377.32), also known as tobacco amblyopia
- Other severe, protein-calorie malnutrition (262), other protein calorie malnutrition (263.8)
- Disturbance of branched-chain amino acid metabolism (270.3)
- As part of a premedication regimen prior to and during treatment with certain drugs/biologicals with potential significant adverse effects, such as provided with Pemetrexed for injection (Alimta® )(995.20*)
*Diagnosis code 995.20 was effective October 1, 2006.
The use of vitamin B-12 injections for conditions other than those listed above will be denied as not medically necessary, and therefore, not covered. A participating, preferred, or network provider cannot bill the member for the denied service.
Oral B-12 vitamins are non-prescription drugs and are not covered. |