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Vitamin B12 Folate Serum Panel

What Do Folate Levels Indicate

Folate Deficiency Vs Vitamin B12 Deficiency

High levels of folate in the blood may mean that you eat a diet rich in folate or folic acid, take vitamins, or take folic acid pills. Consuming more folate than the body needs does not cause problems. High folate levels can also mean a vitamin B12 deficiency. Body cells need vitamin B12 to use folate.

Vitamin B12 And Folate Panel Serum


CPT Code: 82607, 82746

  • Collect and label sample according to standard protocols.
  • Gently invert tube 5 times immediately after draw. DO NOT SHAKE.
  • Allow blood to clot 30 minutes.
  • Centrifuge for 10 minutes.
  • Patient Instructions: Dietary supplements containing biotin may interfere in assays and may skew analyte results to be either falsely high or falsely low. For patients receiving the recommended daily doses of biotin, draw samples at least 8 hours following the last biotin supplementation. For patients on mega-doses of biotin supplements, draw samples at least 72 hours following the last biotin supplementation.

    Transport: Store serum at 2°C to 8°C after collection and ship the same day per packaging instructions included with the provided shipping box.


    Ambient : 36 hoursRefrigerated : 7 daysFrozen : 28 days

    Causes for Rejection: Specimens other than serum improper labeling samples not stored properly samples older than stability limits hemolysis

    Methodology: Immunoassay

    Turn Around Time: 1 to 3 days

    Reference Range: See individual tests for reference ranges

    The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.

    What Do My B12 Folate Test Results Mean

    Normal test results generally mean that there is another cause of a persons bothersome symptoms. In certain cases, however, it may also mean that the levels of these vitamins have not been used up because the health condition has just started. If a deficiency is suspected when test results are normal, then an MMA blood test is typically ordered as a follow-up.

    If there are low levels of these vitamins detected, then in the developed world this typically indicates a pattern of alcoholism, Celiac disease, or pernicious anemia. Crohns disease and ulcerative colitis may also cause deficiencies in these vitamins.

    Having high levels of these vitamins is considered an uncommon test result. Certain conditions, such as severe liver disease, AIDS, and diabetes are known to cause this to happen. People in a stage of heart failure may also see higher than normal results. Being overweight or obese naturally increases B12 and folate levels.

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    What To Eat To Prevent Vitamin B

    Many cases of B-12 deficiency are rooted in underlying health problems, but its possible to take preventative measures. Preventative measures include paying close attention to your diet, especially if youre vegetarian or vegan.

    One serving of fortified breakfast cereal may fulfill 25 to 100 percent of your daily intake value, depending on the brand. Three ounces of cooked salmon has about 80 percent of your daily intake value.

    You can also find B-12 in:

    • seafood

    If A Digestive Issue Is Impacting Your Levels Your Health Coach May Recommend The Following

    Best Vitamin B12 Folate Panel
    • An elimination dietis an affordable and accurate way to rule out trigger foods that may be harming your digestive tract, causing those pesky symptoms like reflux and impacting your ability to absorb B-vitamins.
    • Trigger foods to eliminate for a period of time may include gluten or other grains, dairy, sugar, soy and eggs.
  • Probiotic supportthis may mean taking a multi-strain probiotic supplement and/or increasing your intake of probiotic-rich foods like kombucha, kim chi, cultured vegetables, real pickles, yogurt and kefir.
  • Probiotics can naturally increase synthesis and production of B-vitamins and other nutrients in the gut, such as B12 and folate respectively.
  • Digestive enzyme supportplant-based digestive enzymes or hydrochloric acid supplements offer an effective way to support digestion while you work on healing your GI tract. Food-based sources of enzymes such as papaya, pineapple cultured or raw vegetables, may also be recommended.
  • If youre suffering from a more chronic condition such as an autoimmune disease or infection, your Health Coach may recommend additional measures and/or refer you to a functional medicine physician.

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    How To Address Root Causes And Optimize Your B12 And Folate Levels Safely

    At kNew Health, we often recommend dietary changes and, where appropriate, supplementation to achieve optimal B12 and folate levels quickly and safely.

    For B12 supplementation we typically recommend:

    • 1000 mcg of methylcobalamin 1 -2 times daily

    If you have a digestive issue, sublingual B12 or a lozenge, is often your best choice to enhance absorption.

    For folate supplementation, we typically recommend:

    • 400-800 mcg of methylfolate daily

    Why do we recommend the methyl forms of B12 and folate?

    Methylated B-Vitamins provide superior absorption even in the presence of genetic mutations like MTHFR.

    If youre deficient in both, it may work best to find a high-quality B-complex supplement to cover all your bases.

    What Are The Side Effects Of Too Much Folate

    Although doses up to 5 mg daily have been safely used in some research, doses of folic acid greater than 1 mg daily might cause abdominal cramps, diarrhea, rash, sleep disorders, irritability, confusion, nausea, stomach upset, behavior changes, skin reactions, seizures, gas, excitability, and other side effects.

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    What Is A Folic Acid Test Used For

    A folic acid test is used to measure the amount of folic acid in your bloodstream. Folic acid is a lab-made form of folate, or vitamin B9.

    Low folic acid levels can lead to anemia or birth defects in babies. A folic acid test can help determine whether you would benefit from a folic acid supplement.

    Preparing For A Blood Test

    B12 blood test and Vitamin D and Folate – What does it mean?

    Your healthcare provider will tell you not to eat or drink for about six to eight hours before your test. Youll want to make sure youre well hydrated on the days before the test.

    During the test, your healthcare provider will clean a small area of your arm or elbow with an antiseptic wipe or alcohol pad. They might wrap an elastic band around the top of your arm to increase the flow of blood. Your healthcare provider will then insert the needle into your vein and collect your blood.

    Once enough blood is drawn, your healthcare provider will remove the needle and apply a bandage. Your blood sample is then taken to a lab to measure for vitamin B-12 or other markers, like holoTC.

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    Best Professionally Administered Test: Next Medical Concierge Blood Test

    • Price: $199
    • Turnaround time: 12 to 48 hours after testing
    • Tests for: vitamins B12, B6, and B9

    A unique option, Next Medical is a company that offers at-home vitamin testing on demand. They call their service Uber, but for vitamin testing. If you get queasy thinking about seeing blood or want more guidance from a healthcare professional, this could be a great option for you.

    Youll schedule an appointment online, and a nurse or lab tech will come to your house to collect the blood sample. Because its a local process, you should get results in 12 to 48 hours. A doctor will review your results with you and can recommend a treatment plan or prescribe medications if needed.

    Next Medical is not available everywhere, so you can use their location finder to see if they operate in your area. Although the price is higher than other tests, youll get a full B-vitamin panel and professional attention without leaving the comfort of your home.

    The staff will also walk you through the insurance submission process, if you have insurance. The company estimates that you can get up to 70 percent of the cost covered.

    What Does The Test Measure

    Vitamin B12 is a nutrient that is important for many aspects of human health. Adequate levels of vitamin B12 are needed for your body to maintain a healthy nervous system, make red blood cells, and create DNA, the genetic material present in all of our cells.

    Vitamin B12 occurs naturally in animal proteins, such as red meat, fish, poultry, eggs, and dairy. Other foods, like breakfast cereals, nutritional yeast, and some plant milks, may be fortified with vitamin B12. This vitamin is also available as a supplement and as a prescription medication.

    In food, vitamin B12 is bound to protein. In order for your body to absorb it, the vitamin must be released from the protein. As your body digests food, enzymes in your digestive tract separate vitamin B12 from these proteins. The freed vitamin B12 then combines with a protein made by your body called intrinsic factor, which is secreted by cells in the stomach. Together, vitamin B12 and intrinsic factor are absorbed in the lower end of the small intestine.

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    What Is The Difference Between Serum Folate And Rbc Folate

    Similarly, both serum and red cell folate were shown to increase in response to folic acid supplementation. Overall, serum folate is cheaper and faster to perform than red cell folate, is influenced by fewer analytical variables and provides an assessment of folate status that may be superior to red cell folate.

    How Often To Track Your B12 And Folate Labs

    New Vitamin Status Testing Service

    This should be determined on an individual basis with your Health Coach or Functional Medicine practitioner.

    If your B12 levels are very low and youre experiencing life-altering symptoms, or if youre pregnant and come back very low in folate, for example, re-testing may be recommended in as little as 1-3 months time.

    Curious about how your B12 and folate levels may be impacting your health? Were here to help.

    All kNew Health members receive a B12 and RBC-folate lab workup as part of their initial assessment, along with a dedicated Health Coach to help you optimize your levels for the long-term.

    -The Knew Health Team

    Joshua Rosenthal

    Knew Health is only available in the US, excluding Vermont , Alaska, Washington. Please contact us with any questions.

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    When Should I Get Vitamin B12 Testing

    Vitamin B12 testing is usually performed when you have symptoms of a vitamin B12 deficiency, such as anemia or nervous system problems. Some people are at a greater risk of having a vitamin B12 deficiency due to their age or preexisting health conditions and may undergo regular vitamin B12 testing to check whether their B12 levels are normal.

    The following information describes several circumstances in which vitamin B12 testing may be recommended by a doctor.


    Anemia is a condition in which your body does not have enough healthy red blood cells. Red blood cells carry oxygen to your body tissues. When you dont have enough healthy, properly functioning red blood cells, you may have symptoms like:

    • Fatigue
    • Changes in the way a person walks
    • Dementia, a condition that affects mental functions such as memory and language skills

    Risk factors

    Certain factors make an individual more likely to have a vitamin B12 deficiency. Your doctor may order vitamin B12 testing for you if you have one or more of the following risk factors:

    • Age over 75 years
    • Medication interactions with drugs that interfere with vitamin B12 absorption, including histamine blockers, proton pump inhibitors, metformin and nitrous oxide
    • Pancreatic insufficiency, a condition that can affect how well enzymes are able to separate vitamin B12 from food proteins

    Understanding Of Lab Tests Results

    Please visit the site associated with The American Association for Clinical Chemistry for better understanding of tests. There you will find the most detailed and full information regarding lab tests. In “common questions” tab you will find answers on the most common questions.

    In addition, you can use a special form to ask the question. It is useful, if there is no answer on your question on the web site. A laboratory scientist will answer your question. It is a part of voluntary service provided by the American Society for Clinical Laboratory Science.

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    The Root Causes Of B12 And/or Folate Deficiencies

    We hinted above that the root causes of B12 or folate deficiency may go beyond diet lets look at those causes now:

    • Diettypically those following a vegan, vegetarian or very restrictive diet are at higher risk of B12 deficiency, because B12 is only found in animal foods.

    Insofar as folate goes, anyone who is not eating enough dark leafy greens, nuts and seeds will be at higher risk of folate deficiency as these natural sources are the most absorbable.

    The synthetic folic acid found in cheap supplements and fortified foods is typically poorly absorbed by much of the population, especially those with genetic mutations .

  • Autoimmune diseasesif you have an autoimmune disease like celiac or Crohns disease, it typically impacts your digestive health which can cause, or exacerbate, vitamin deficiencies
  • Pernicious anemia is also an autoimmune disease that directlyand dramaticallyimpairs Vitamin B12 absorption.
  • When To See A Doctor About The B12 Folate Blood Test

    How can folate mask a vitamin B12 deficiency?

    This blood test is ordered most often when there are behavioral changes seen in certain population groups. The elderly are especially vulnerable to having low levels of B12 and folate in their body. It may be ordered as part of a complete blood count during a checkup or in conjunction with a number of additional tests.

    People who are experiencing tingling, burning, or numbing sensations that are unusual may also wish to have these vitamin levels checked. Without enough B12 or folate, the myelin which protects nerve endings can become damaged and cause unusual sensations or create involuntary muscle twitches.

    If there are conditions that may cause malnutrition, then this blood test can also be useful to determine the rate of malabsorption. This is most often seen with alcoholism and inflammatory bowel conditions like Celiac disease, but may also be present with liver disease, certain cancers, and cystic fibrosis.

    In addition to the symptoms described above, a deficiency in B12 and folate may cause fatigue, muscle weakness, pale skin, a sore tongue and mouth, paranoia, diarrhea, and dizziness.

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    B12 Folate Blood Test Results Explained

    Sometimes B12 and folate blood tests are ordered independently from each other, but the B12 folate blood test is growing in popularity because it can help to determine the presence of a deficiency. Sometimes deficiencies in these items is due to dietary habits, but most often it is due to the presence of an anemia or an autoimmune disease. These two vitamins are important because they cannot be produced by the body whatsoever.

    B12 is essential for nerve function. Folate helps B12 be able to form normal red blood cells, help to repair cells and tissues, and even provide DNA synthesis. If these vitamins are not at normal levels, the damage that occurs within the body may not completely repair itself, which is why this blood test is ordered on a regular basis to determine the state of a persons general health.

    What Happens During A Vitamin B Test

    Vitamin B levels may be checked in blood or urine.

    During a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

    Vitamin B urine testing may be ordered as a 24-hour urine sample test or a random urine test.

    For a 24-hour urine sample test, you’ll need to collect all urine passed in a 24-hour period. This is called a 24-hour urine sample test. Your health care provider or a laboratory professional will give a container to collect your urine and instructions on how to collect and store your samples. A 24-hour urine sample test generally includes the following steps:

    • Empty your bladder in the morning and flush that urine away. Record the time.
    • For the next 24 hours, save all your urine passed in the container provided.
    • Store your urine container in the refrigerator or a cooler with ice.
    • Return the sample container to your health provider’s office or the laboratory as instructed.

    For a random urine test, your sample of urine may be collected any time of the day.

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    Can I Take The Test At Home

    Several test kits are commercially available that allow you to collect a sample for vitamin B12 testing at home. Some kits test only your vitamin B12 level. Others test B12 in combination with other vitamins.

    These kits may be purchased online and include the materials you need to obtain a sample of blood using a finger prick, which you return to the manufacturer for testing. Your test results are available after a few days via a secure online platform.

    At-home testing is convenient and allows you to participate in your own health care. However, at-home tests cannot take the place of working with a health care provider. If you have symptoms or are worried that you may have a low level of vitamin B12, be sure to share your concerns with a doctor or nurse.

    If an at-home test detects an abnormal vitamin B12 level, your doctor is likely to retest your vitamin B12 and follow up with additional testing if the second vitamin B12 test is also abnormal.


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