82610
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Required documentation and claim substantiation should follow the documentation requirements and MolDX program instructions in LCD L36362; no additional specific forms or certifications are specified in this article.
- Article provides billing, coding, and guideline information that complements LCD L36139; claims must follow the LCD and MolDX program requirements (including appropriate CPT/HCPCS and ICD-10 coding and any LCD-required documentation or prior authorization).
- Follow the Local Coverage Determination MolDX: Biomarkers in Cardiovascular Risk Assessment (L36523) for required documentation, medical necessity criteria, and claim submission instructions; this article provides supplemental billing and coding guidance only.
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Key Coverage Criteria
- No clinical indications are specified in this article; coverage indications are determined by the referenced LCD L36362 (MolDX: Biomarkers in Cardiovascular Risk Assessment).
- This article contains billing and coding guidance only and does not itself define clinical indications; refer to MolDX: Biomarkers in Cardiovascular Risk Assessment LCD L36139 for covered clinical indications.
- Cystatin C measurement is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L37561.
- Medicare Part B covers the basic lipid panel (total cholesterol, HDL-C, triglycerides, LDL-C) for cardiovascular disease screening every 5 years when ordered by a physician.
- Lipid panel testing is covered for symptomatic patients to evaluate atherosclerotic cardiovascular disease and to monitor progress on anti-lipid dietary management or pharmacologic therapy (NCD 190.23).
- Individual lipid biomarkers may be covered when specifically ordered to characterize a patient's lipid abnormality, determine a treatment plan, or assist with therapy intensification, provided the ordering clinician documents the specific reason in the medical record.
20 Active Policies
L36523 — MolDX: Biomarkers in Cardiovascular Risk Assessment
J05
A57559 — Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment
J05
A57682 — Billing and Coding: Cystatin C Measurement
J09
L37561 — Cystatin C Measurement
J09
CGS-L37598
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.