CPT Code: 82465 Lipids Testing


Frequency Limitations: When monitoring long term anti-lipid dietary or pharmacologic therapy and when following patients with borderline high total or LDL cholesterol levels, it is reasonable to perform the lipid panel annually. A lipid panel (CPT code 80061) at a yearly interval will usually be adequate while measurement of the serum total cholesterol (CPT code 82465) or a measured LDL (CPT code 83721) should suffice for interim visits if the patient does not have hypertriglyceridemia (for example, ICD-9-CM code 272.1, Pure hyperglyceridemia). 

Any one component of the panel or a measured LDL may be medically necessary up to six times the first year for monitoring dietary or pharmacologic therapy. More frequent total cholesterol HDL cholesterol, LDL cholesterol and triglyceride testing may be indicated for marked elevations or for changes to anti-lipid therapy due to inadequate initial patient response to dietary or pharma-cologic therapy. The LDL cholesterol or total cholesterol may be measured three times yearly after treatment goals have been achieved. If no dietary or pharmacological therapy is advised, monitoring is not necessary. 

When evaluating non-specific chronic abnormalities of the liver (for example, elevations of transaminase, alkaline phosphatase, abnormal imaging studies, etc.), a lipid panel would generally not be indicated more than twice per year.






MEDICARE LIMITATIONS AND GUIDELINES:

When monitoring long-term anti-lipid dietary or pharmacologic therapy and when following patients with borderline high total or LDL cholesterol levels, it is reasonable to perform the lipid panel annually. A lipid panel (CPT code 80061) at a yearly interval will usually be adequate while measurement of the serum total cholesterol (CPT code 82465) or a measured LDL (CPT code 83721) should suffice for interim visits if the patient does not have hypertriglyceridemia (for example, ICD-9-CM code 272.1, Pure hyperglyceridemia).

Any one component of the panel or a measured LDL may be medically necessary up to six times the first year for monitoring dietary or pharmacologic therapy. More frequent total cholesterol HDLcholesterol, LDL cholesterol and triglyceride testing may be indicated for marked elevations or for changes to anti-lipid therapy due to inadequate initial patient response to dietary or pharmacologic therapy. The LDL cholesterol or total cholesterol may be measured three times yearly after treatment goals have been achieved. If no dietary or pharmacological therapy is advised, monitoring is not necessary.

When evaluating non-specific chronic abnormalities of the liver (for example, elevations of transaminase, alkaline phosphates, abnormal imaging studies, etc.), a lipid panel would generally not be indicated more than twice per year.

 CMS (Medicare) has determined that Lipid Testing (CPT Codes 80061, 82465, 83700, 83701, 83704, 83718, 83721, 84478) is only medically necessary and, therefore, reimbursable by Medicare when ordered for patients with any of the diagnostic conditions listed below in the “ICD-9-CM Codes Covered by Medicare Program.” If you are ordering this test for a diagnostic condition other than those listed below, please have your patient sign and date an Advanced Beneficiary Notice (ABN)

Utilization Guidelines 

• The first follow up LDL determination and assessment of possible adverse biochemical changes should be made 6-8 weeks after initiating drug therapy. If the target LDL cholesterol is not achieved with the initial dose, then drug titration should be used to find the optimum dose – with measurements made every 6-8 weeks while medication is being adjusted.

• When monitoring long term anti-lipid therapy and following patients with borderline high total or LDL cholesterol, a lipid panel would reasonably be performed once per year.

• After 1 year of therapy during which the response has been established and there is no evidence of biochemical toxicity, patients should be followed at 4- to 6-month intervals – with total cholesterol or LDL.

• A yearly lipid panel would be reasonable and necessary to monitor patients with borderline high cholesterol, who are not being treated, or in patients who are stable on dietary therapy.

• Measurement of the total serum cholesterol (CPT code 82465) or a measured LDL (CPT code 83721) should suffice for interim visits if the patient does not have hypertriglyceridemia.

• Any one component of the panel or a measured LDL may be reasonable and necessary up to six times in the first year for monitoring dietary or pharmacologic therapy. More frequent total cholesterol HDL, cholesterol, LDL cholesterol and triglyceride testing may be indicated for marked elevations or for changes to anti-lipid therapy due to inadequate initial patient response to dietary or pharmacologic therapy.

• After treatment goals have been achieved, LDL or total cholesterol may be measured three times per  year.


ICD-9 Codes are associated with CPT code 82465 in this policy.


82465 CHOLESTEROL, SERUM OR WHOLE BLOOD, TOTAL

*ICD-9-CM codes V81.0, V81.1 and V81.2 are only payable for CPT codes 80061, 82465, 83718 and 84478.

…. and many more.

For CPT codes 80061, 82465, 83718, and 84478

All of the above codes plus the following additional codes are covered

V81.0 Special screening for cardiovascular, respiratory, and genitourinary diseases;  Ischemic heart disease

V81.1 Special screening for cardiovascular, respiratory, and genitourinary diseases;  hypertension

V81.2 Special screening for cardiovascular, respiratory, and genitourinary diseases; other and unspecified cardiovascular
conditions