Lipid Profile & Cholesterol Testing National Coverage Determination Numerical Sort:
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1 Lipid Profile & Cholesterol Testing National Coverage Determination CPT Codes: Lipid Panel Cholesterol, serum or whole blood, total Lipoprotein, blood; electrophoretic separation and quantitation Lipoprotein blood; high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (eg, electrophoresis, ultracentrifugation) Lipoprotein blood; quantitation of lipoprotein particle numbers and lipoprotein particles subclasses Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) Lipoprotein, direct measurement, LDL cholesterol Triglycerides Numerical Sort: Disorders of the thyroid gland with hormonal dysfunction Diabetes, secondary Diabetes mellitus Cushing s syndrome 260 Kwashiorkor 261 Nutritional marasmus 262 Other severe, protein-calorie malnutrition Malnutrition of moderate degree Malnutrition of mild degree Other protein-calorie malnutrition Unspecified protein-calorie malnutrition Disturbances of amino acid transport Galactosemia Pure hypercholesterolemia Pure hyperglyceridemia Mixed hyperlipidemia Hyperchylomicronemia Other and unspecified hyperlipidemia Lipoprotein deficiencies Lipodystrophy Lipidoses Other disorders of lipoid metabolism Unspecified disorder of lipoid metabolism Amyloidosis Overweight and obesity Other and unspecified alcohol dependence Other background retinopathy and retinal vascular changes Retinal vascular occlusion Retinal exudates and deposits Senile corneal changes Xanthelasma Crystalline deposits in vitreous Degenerative and vascular disorders, unspecified Transient ischemic deafness Essential hypertension, malignant Essential hypertension, benign Essential hypertension, unspecified Hypertensive heart disease Hypertensive chronic kidney disease Hypertensive heart and chronic kidney disease Secondary hypertension January 2015 Medicare Limited Coverage Tests
2 Acute mycocardial infarction Other acute and subacute forms of ischemic heart disease Acute coronary occlusion without myocardial infarction Other acute and subacute forms of ischemic heart disease 412 Old myocardial infarction Angina pectoris Other and unspecified angina pectoris Other forms of chronic ischemic heart disease Of artery bypass graft Of unspecified type of bypass graft Coronary atherosclerosis of coronary artery of transplanted heart Of bypass graft (atery) (vein) of transplanted heart Aneurysm of heart (wall) Aneurysm of coronary vessels Dissection of coronary artery Chronic ischemic heart disease, unspecified Atherosclerosis, coronary, due to lipid rich plaque Atherosclerosis, coronary, due to calcified coronary lesion Other specified forms of chronic ischemic heart disease Chronic ischemic heart disease, unspecified Heart failure Cardiovascular disease, unspecified Heart disease, unspecified 431 Intracerebral hemorrhage Occlusion and stenosis of precerebral arteries Occlusion of cerebral arteries Transient cerebral ischemia Cerebral atherosclerosis Other generalized ischemic cerebrovascular disease Moyamoya disease Other late effects of cerebrovascular disease Atherosclerosis Aortic aneurysm and dissection Of artery of upper extremity Of renal artery Of iliac artery Arterial embolism and thrombosis Chronic vascular insufficiency of intestine Other chronic nonalcoholic liver disease Unspecified chronic liver disease without mention of alcohol Other specified disorders of liver Syndrome, hepatopulmonary Unspecified disorder of liver Diseases of pancreas Other and unspecified postsurgical nonabsorption Other specified intestinal malabsorption Nephrotic syndrome With lesion of tubular necrosis Chronic kidney disease Renal osteodystrophy Nephrogenic diabetes insipidus Other specified disorders resulting from impaired renal function Unspecified disorder resulting from impaired renal function Impotence of organic origin Liver and biliary tract disorders in pregnancy, antepartum condition or complication Thyroid dysfunction Psoriatic arthropathy Other psoriasis Biliary atresia Light-for-dates without mention of fetal malnutrition Medicare Limited Coverage Tests January 2015
3 Chest pain, unspecified Precordial pain Chest pain, other Hepatomegaly Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase (LDH) Other nonspecific abnormal serum enzyme levels Other abnormal blood chemistry Gastrointestinal tract Toxic effect of unspecified gas, fume, or vapor Complications of transplanted organ, kidney V42.0 Transplant, kidney V42.7 Transplant, liver V58.63 Long-term (current) use of antiplatelets/antithrombotics V58.64 Long-term (current) use of non-steroidal anti-inflammatories (NSAID) V58.69 Long-term (current) use of other medications V81.0-V81.2 Special screening for cardiovascular, respiratory, and genitourinary diseases (covered only for procedure codes 80061, 82465, & 84478) Medicare Limited Coverage Tests Covered Diagnosis Codes Source: National Coverage Determinations January 2013 Coding Policy Manual and Change Report January 2015 Medicare Limited Coverage Tests
4 Lipid Profile & Cholesterol Testing, Continued Alphabetical Sort: Amyloidosis Aneurysm; aortic aneurysm and dissection Aneurysm; coronary vessels Aneurysm; heart (wall) Aneurysm; iliac artery Aneurysm; renal artery Aneurysm; upper extremity, artery of Angina pectoris Angina; other and unspecified agina pectoris Anomaly; biliary atresia Arteriosclerosis; Atherosclerosis Arteriosclerosis; cerebral atherosclerosis Atherosclerosis; coronary, due to calcified coronary lesion Atherosclerosis; coronary, due to lipid rich plaque Arteriosclerosis; of artery bypass graft Arteriosclerosis; of unspecified type of bypass graft Arthropathy; psoriatic arthropathy Bypass; of graft (atery) (vein) of transplanted heart Changes; senile corneal changes Cirrhosis; fatty, other chronic nonalcoholic liver disease Complications of transplanted organ, kidney Coronary athersclerosis of coronary artery of transplanted heart Cushing s syndrome Deficiency; lipoprotein deficiencies Dependence; other and unspecified alcohol Deposit; cholesterol, retinal exudates and deposits Deposit; crystalline deposits in vitreous Diabetes; complication, diabetes mellitus Diabetes; nephrogenic diabetes insipidus Diabetes, secondary Disease; cardiovascular disease, unspecified Disease; cryptogenic, heart disease, unspecified Disease, kidney, chronic Disease; liver, unspecified chronic liver disease without mention of alcohol Disease; liver, unspecified disorder of liver Disorder; degenerative and vascular disorders, unspecified Disorder; lipid, metabolism, unspecified disorder of lipoid metabolism Disorder; other disorders of lipoid metabolism Dissection of coronary artery Disturbances of amino acid transport Dysfunction; thyroid dysfunction Embolism; arterial embolism and thrombosis Failure, heart failure Findings, abnormal, without diagnosis; gastrointestinal tract Findings, abnormal, without diagnosis; nonspecific elevation of levels of transaminase or lactic acid dehydrogenase (LDH) Findings, abnormal, without diagnosis; other abnormal blood chemistry Findings, abnormal, without diagnosis; other nonspecified abnormal serum enzyme levels Galactosemia 431 Hemorrhage; brain, intracerebral Hepatomegaly Hepatoptosis; other specified disorders of liver Hypercholesterolemia; pure Hyperchylomicronemia Medicare Limited Coverage Tests January 2015
5 272.1 Hyperglyceridemia; pure Hyperlipidemia; mixed hyperlipidemia Hyperlipidemia; other and unspecified Hypertension; essential, hypertension, benign Hypertension; essential, hypertension, malignant Hypertension; essential, hypertension, unspecified Hypertension; hypertensive heart and chronic kidney disease Hypertension; hypertensive heart disease Hypertension; hypertensive chronic kidney disease Hypertension; secondary Hyperthyroidism; disorders of the thyroid gland with hormonal dysfunction Impaired; other specified disorders resulting from impaired renal function Impaired; unspecified disorder resulting from impaired renal function Impotence of organic origin 412 Infarction; healed or old, old myocardial infarction Infarction; myocardium, acute mycocardial Infarction; other acute and subacute forms of ischemic heart disease Insufficiency; mesenteric, chronic vascular insufficiency of intestine Ischemia; other acute and subacute forms of ischemic heart disease Ischemia; transient cerebral Ischemic; chronic ischemic heart disease, unspecified Ischemic; chronic ischemic heart disease, unspecified Ischemic; other forms of chronic ischemic heart disease Ischemic; other generalized ischemic cerebrovascular disease Ischemic; other specified forms of chronic ischemic heart disease 260 Kwashiokor Late; other last effects of cerebrovascular disease Lipidoses Lipodystrophy V58.63 Long-term (current) use of antiplatelets/antithrombotics V58.69 Long-term (current) use of other medications V58.64 Long-term (current) use of non-steroidal anti-inflammatories (NSAID) Malabsorption; other and unspecified postsurgical nonabsorption Malabsorption; protein, other specified intestinal Malnutrition of mild degree Malnutrition of moderate degree Malnutrition; Light-for-dates without mention of fetal malnutrition Malnutrition; other protein-calorie 262 Malnutrition; other severe, protein-calorie malnutrition Malnutrition; unspecified 261 Marasmus; nutritional marasmus Moya moya disease Necrosis; with lesion of tubular necrosis Nephrosis; nephrotic syndrome Overweight and obesity Occlusion; artery; cerebral arteries Occlusion; artery; coronaryl; acute; without myocardial infarction Occlusion; artery; stenosis of precerebral arteries Occlusion; retinan; artery;vascular occlusion Osteodystrophy; azotemic, renal osteodystrophy Pain; chest pain, other Pain; chest pain, unspecified Pain; precordial pain Pancreatitis; diseases of pancreas Pregnancy; atrophy, liver disorders antepartum Pregnancy; liver disorders in pregnancy Psoriasis; other Retinopathy; other background retinopathy and retinal vascular changes January 2015 Medicare Limited Coverage Tests
6 V81.0-V81.2 Screening, special screening for cardiovascular, respiratory, and genitourinary diseases (covered only for procedure codes 80061, 82465, & 84478) Syndrome, hepatopulmonary Toxic effect of unspecified gas or vapor (See Table of Drugs and Chemicals; poisoning) Transient ischemic deafness V42.0 Transplant; organ or tissue replaced by transplant, kidney V42.7 Transplant, organ or tissue replaced by transplant, liver Xanthelasma Medicare Limited Coverage Tests Covered Diagnosis Codes Source: National Coverage Determinations January 2013 Coding Policy Manual and Change Report Medicare Limited Coverage Tests January 2015
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Test Code Test Name CPT CHOL Cholesterol, Serum 82465 HDL HDL, (High Density Lipoprotein) 83718 TRIG Triglycerides, Serum 84478 FTRIG Triglycerides (Fluid) 84478 LIPID Lipid Panel 80061 LDL LDL (Low Density
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