|MP 2.01.12||Vitamin B12 Injection|
|Original Policy Date
|Last Review Status/Date
Reviewed with literature search/4:2003
|Return to Medical Policy Index|
Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.
Vitamin B12 or cyanocobalamin is essential to cell maturation, and deficiencies can result in certain characteristic anemias and neurological disorders. Cyanocobalamin, which is a synthetic, crystalline substance, is administered by subcutaneous injection to individuals with vitamin B12 deficiencies.
Vitamin B12 injections may be considered medically necessary in the treatment of vitamin B12 deficiency conditions, which include the following:
1. Anemias secondary to vitamin B12 deficiency (as shown by macrocytosis, low serum B12 , abnormal Schilling test), such as:
- Pernicious anemia;
- Fish tapeworm anemia;
- Macrocytic megaloblastic anemias resulting from gastrointestinal disorders;
- Anemias resulting from postgastrectomy;
2. Gastrointestinal disorders:
- Malabsorption syndromes such as sprue and idiopathic steatorrhea;
- Anemia resulting from small intestine resections, strictures, or blind loop syndromes;
3. Neuropathies secondary to vitamin B12 deficiency:
- Acute phase exacerbation due to malnutrition or alcoholism;
- Combined system degeneration (lateral sclerosis);
4. Dementias secondary to vitamin B12 deficiency.
In the absence of a vitamin B12 deficiency, other indications for vitamin B-12 injections are considered not medically necessary, including but not limited to, as a technique to lower homocysteine levels in an effort to reduce cardiovascular risk, strengthening tendons, ligaments, etc., of the foot, or in the treatment of arthritis, multiple sclerosis, senility, neuritis, diabetic neuropathy, shingles, leukemia, lupus erythematosus, or delayed growth.
No applicable information
Vitamin B12 injections administered during an office visit may be paid as part of the office visit.
When an injection is given without an office visit, it is billed using HCPCS code J3420.
A search of the literature based on the MEDLINE database for the period of 1998 to September 2003 was performed with a focus on the role of vitamin B12 injections as a technique to lower homocysteine levels, based on the results of epidemiologic studies that have show an association between homocysteine levels and cardiovascular risk. While several studies were identified that discussed vitamin B12 as a homocysteine-lowering therapy, all studies focused only on oral supplementation, and not vitamin B12 injections. (1-3) A variety of other studies specifically focused on patients receiving renal dialysis; elevated levels of homocysteine are common in this population. (4-6) Again, these studies focused on oral supplementation.
- Schnyder G, Roffi M, Flammer Y et al. Effect of homocysteine-lowering therapy on restenosis after percutaneous coronary intervention for narrowing in small coronary arteries. Am J Cardiol 2003; 91(10):1265-9.
- Schnyder G, Roffi M, Flammer Y et al. Effect of homocysteine-lowering therapy with folic acid, vitamin B12, and vitamin B6 on clinical outcome after percutaneous coronary intervention: the Swiss Heart Study: a randomized controlled trial. JAMA 2002; 288(8):973-9.
- Schnyder G, Roffi M, Pin R et al. Decreased rate of coronary restenosis after lowering of plasma homocysteine levels. N Engl J Med 2001; 345(22):1593-600.
- Marcucci R, Zanazzi M, Bertoni E et al. Vitamin supplementation reduces the progression of atherosclerosis in hyperhomocysteinemic renal-transplant recipients. Transplantation 2003; 75(9):1551-5.
- Amadottir M, Hultberg B. The effect of vitamin B12 on total plasma homocysteine concentration in folate-replete hemodialysis patients. Clin Nephrol 2003; 59(3):186-9.
- Manns B, Hyndman E, Burgess E et al. Oral vitamin B(12) and high-dose folic acid in hemodialysis patients with hyper-homocyst(e)inemia. Kidney Int 2001; 59(3):1103-9.
|CPT||90772||Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular (new code effective 1/1/06)|
|ICD-9 Procedure||99.29||Injection or infusion of other therapeutic or prophylactic substance|
|ICD-9 Diagnosis||123.4||Fish tapeworm anemia|
|266.2||Vitamin B12 deficiency|
|281.0 and 336.2||Combined cord degeneration with anemia (pernicious)|
|281.1 and 336.2||Combined cord degeneration with anemia due to dietary or B12 deficiency|
|281.3||Other specified megaloblastic anemias|
|281.9||Megaloblastic anemia, malnutrition, or alcoholism|
|294.1 and 266.2||Dementia in conditions classified elsewhere, vitamin B12 deficiency|
|357.4||Polyneuropathy in diseases classified elsewhere|
|579.1||Sprue, tropical and not otherwise specified|
|579.2||Blind loop syndrome|
|579.3||Other postsurgical non-absorption|
|579.8||Other intestinal malabsorption, specified|
|HCPCS||J3420||Injection, vitamin B-12 cyanocobalamin, up to 1,000 mcg|
|Type of Service||Injection|
|Place of Service||Inpatient
Vitamin B12 Injections
|12/01/95||Add to Medicine section||New policy|
|07/31/97||Replace policy||Reviewed with changes; revised description|
|04/15/02||Replace policy||Policy reviewed without literature search; new review date only|
|12/17/03||Replace policy||Policy reviewed with literature search; policy statement essentially unchanged, added discussion regarding vitamin B12 supplementation as a technique to lower homocysteine levels|
|12/14/05||Replace policy – coding update only||CPT coding updated|