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MP 2.01.12 Vitamin B12 Injection

 

Medical Policy    
Section
Medicine
Original Policy Date
12/1/95
Last Review Status/Date
Reviewed with literature search/4:2003
Issue
4:2003
  Return to Medical Policy Index

Disclaimer

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.

 


 

Description

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.

 


 

Policy

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.

 


 

Policy Guidelines

No applicable information

 


 

Benefit Application

 

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.

 


 

Rationale

2003 Update

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.

 

References:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  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.
  6. 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.

 

Codes

Number

Description

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  Pernicious anemia 
  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 
  281.2  Macrocytic anemia 
  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 
  579.0  Idiopathic steatorrhea 
  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 
  579.9  Malabsorption syndrome 
HCPCS  J3420  Injection, vitamin B-12 cyanocobalamin, up to 1,000 mcg 
Type of Service  Injection 
Place of Service  Inpatient
 
Outpatient
 
Physician’s Office
 

 


 

Index

Cyanocobalamin
Vitamin B12 Injections

 


 

Policy History

Date Action Reason
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