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Diagnoses that typically trigger coverage: Pernicious anemia (D51.0): autoimmune destruction of intrinsic factor, preventing B12 absorption B12 deficiency anemia (D51.9): documented low B12 with anemia Malabsorption syndromes (K90.9): Crohn's disease, celiac disease, post-bariatric surgery Atrophic gastritis (K29.4): reduced stomach acid impairing B12 absorption Post-gastrectomy (Z90.3) or post-gastric bypass (Z98.84) Diagnoses that typically don't trigger coverage: Fatigue (R53.83) without documented B12 deficiency "Wellness" or "preventive health" Chronic fatigue syndrome (G93.3) without low B12 labs Fibromyalgia (M79.7) Depression (F32.x, F33.x) without B12 deficiency Lab thresholds: Most commercial plans require a B12 level below 200 to 300 pg/mL to approve coverage
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